COVID continues to rise, but life is returning to normal everywhere you look. When will the pandemic really be over?

COVID never goes away. But the pandemic will inevitably end at some point. Right?

For many it already is, with masks, social distancing and frequent hand washing relegated to a traumatic past they don’t want to revisit.

This week, the Biden administration extended the US public health emergency for another 90 days, although officials from the US Department of Health and Human Services recently warned states that the state of emergency could soon take hold. end. World Health Organization officials also continue to express optimism that the global health emergency will end this year. A committee meeting on the matter is scheduled for January 27.

Are we – or are we not – still in a pandemic, three years later? There are no consensus definitions for the terms “pandemic” and “endemic”, which loosely refer to an outbreak of disease affecting the world and a particular region such as a country, respectively. Given the lack of agreement, it is impossible to say for sure whether the pandemic is underway. Personal opinions vary and shades of gray abound.

When will we all agree? Will we ever?

“Unfortunately, ‘pandemic’ is really more of a political and sociological term than a scientific term,” said Dr. Jay Varma, chief medical adviser at New York-based think tank Kroll Institute. Fortune. A 20-year veteran of the United States Centers for Disease Control and Prevention, Varma was the primary architect of New York’s COVID-19 pandemic response before joining the institute in March.

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

“It is certainly not the scientists who decide that. Public health officials would say that is not acceptable.

Dr. Michael Merson, a visiting professor at New York University’s School of Global Public Health, echoed Varma’s comments, saying Fortune that the general public has accepted that the pandemic is over, at the cost of massive losses.

Conditions are better than they were at the start of 2020, he concedes. COVID, however, “is still causing — to me — an unacceptable number of deaths,” he said, adding that society’s acceptance of the body count — hundreds of thousands a year in the United States alone — is “disturbing”.

Not now, ever

Of all time to declare the end of the pandemic, it is not the case now, say many public health experts. The reason: China’s recent outburst after years of “zero COVID” restrictions. The reopening appears to have happened with little, if any, planning, leaving the majority of China’s 1.4 billion people vulnerable to illness, hospitalization, death and the long COVID–simultaneously.

The reopening also serves as a wild card for the world, putting it at risk for potentially dangerous new variants that are statistically more likely to occur there, given the ultra-high levels of transmission. Chinese New Year gatherings on January 22 are likely to fuel further transmission. In addition, the Chinese government is once again allowing residents to travel abroad.

China aside, levels of the potentially daunting XBB.1.5 COVID variant, dubbed “Kraken,” are rising in the United States. They have played a role in a recent rise in hospitalizations in the northeast – a trend that could play out in the rest of the country as the virus spreads west. Other countries could eventually find themselves in a similar situation.

XBB.1.5’s ascension “is just a reminder that while he’d like this pandemic to be over, it’s not,” Varma said.. “The virus is not behaving like it wants this pandemic to be over.”

Still, it may be time to end emergency declarations, said Dr. Georges Benjamin, head of the American Public Health Association, a 150-year-old organization of public health professionals that seeks to promote health and health equity in the United States. Fortune.

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

“The decision makers no longer want to fund it; people don’t want to pay attention to it anymore,” he said. “It’s a matter of human behavior. If everything is an emergency, nothing is.

But declaring the emergency over doesn’t mean the pandemic is over, Benjamin warned.

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

How to get out of the pandemic

There are a few generally accepted pathways out of pandemic status, said Dr. Bruce Y. Lee, professor of health policy and management at the City University of New York School of Public Health. Fortune.

One of them: when the level of COVID infections drops enough around the world. The virus could settle into a pattern of true seasonality, similar to what is seen with RSV and influenza, in which cases are virtually non-existent in the summer and increase in the winter. Or COVID levels could decline — somewhat — to a prolonged “high plateau,” with a relatively high level of cases occurring throughout the year.

A transition to the later storyline could be underway now, Lee argues. Case spikes are not as high as they were at the start of the pandemic. The valleys between the peaks are also not as low as they used to be, which paints a potential picture of a future COVID-endemic with persistently high levels of viral transmission.

A seasonal pattern would be best, Lee says.

“We don’t want to have higher plateaus or consistent levels throughout the year,” he said. “It’s a lot harder to manage than something seasonal.”

A glorified cold or flu?

As the United States continues to grapple with a “triple epidemic” of COVID, RSV, and influenza, public health officials are warning those with symptoms like fever and malaise not to assume they have the flu and test for COVID. It’s virtually impossible to tell the two apart based on symptoms right now, experts say.

It’s a reality that fuels office water cooler debates about the continued legitimacy of the pandemic. How can COVID still have pandemic status if it is indistinguishable from the flu or, for some, a cold?

It’s a good question, but with a simple answer: cold viruses rarely kill, and the flu doesn’t kill as often as COVID.

“Psychologically, I’m afraid the public will accept our current situation as the pandemic is over, despite the fact that we have 250,000, 300,000 deaths a year, far more than we have with the flu,” he said. said Merson, of New York University. .

Last season, the flu killed about 5,000 Americans, according to the US Centers for Disease Control and Prevention. It was a mild flu year, of course, thanks to pandemic precautions. But the annual number of flu deaths regularly counts in the tens of thousands, not the hundreds of thousands like COVID deaths. Since the start of the pandemic, COVID has killed nearly 1.1 million Americans. The flu has killed less than 50,000 people.

While the public and many public health experts continue to disagree on the state of the pandemic, Lee says things are looking up for the time being.

In 2020, many public health experts predicted the pandemic would last about 2.5 to 3 years, he says – about the duration of the 1918 flu pandemic and other epidemics, such as the Japanese smallpox epidemic. of 735-737, the Black Death and the Italian Plague of 1629-1631.

“We’re pretty much on schedule, more or less — more more — than we originally planned,” Lee said. “This suggests that 2023 could be the big transition year. We are seeing good trends.

This story was originally featured on Fortune.com

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