Is COVID-19 Still a Pandemic?
Or is it becoming an endemic disease? A BU virologist, epidemiologist, and physician reflect on the status of the virus as the CDC cuts isolation period to 24 hours
Is COVID-19 Still a Pandemic?
Or is it becoming an endemic disease? A BU virologist, epidemiologist, and physician reflect on the status of the virus as the CDC cuts isolation period to 24 hours
Can we finally throw away the masks? Three BU experts share their perspectives on the shifting status of COVID-19. Photo via iStock/ArtMarie
First it was 14 days, then 10 days, to 7 days, then down to 5 days—the time we’re supposed to isolate after testing positive for COVID-19 has changed drastically since the start of the pandemic. And now the Centers for Disease Control and Prevention (CDC) has cut it to 24 hours, after a person is fever-free and symptoms are improving.
All of these changes, plus the widespread relaxation of mask policies in public places, begs the question: Are we still in a pandemic? Or has COVID-19 reached the endemic stage, meaning it’s here to stay, but not spreading out of control? The terminology can be confusing—for example, the World Health Organization still calls COVID-19 a pandemic, even after declaring an end to the public health emergency last spring.
The Brink asked three Boston University researchers—a virologist, an epidemiologist, and an emergency room physician—to explain the shifting status of COVID, how to decide when a virus has gone from a pandemic to endemic, how much people should protect themselves and others, and why language matters. Here are their expert takes, in their own words:
The Physician: Out of the Disruptive Phase
Sabrina Assoumou, BU Chobanian & Avedisian School of Medicine Louis W. Sullivan, MD, Professor of Medicine and associate professor of medicine and attending infectious diseases physician at Boston Medical Center, BU’s primary teaching hospital
It might be helpful to refer to definitions. A pandemic is defined as a widespread disease outbreak that causes disruption on a global scale. This could be contrasted with the definition for endemic, which is, “the constant presence of a disease or infectious agent within a given geographic area or population group.”
It is difficult to identify a shift from pandemic to endemic in real time. The assessment is often made when looking back in time and reassessing the situation. What we can say about the current situation is that we are no longer in a phase where society is experiencing widespread disruptions because of the virus. As an infectious diseases physician, I am not seeing large numbers of individuals presenting with severe disease and needing to be hospitalized. This is because of population-level immunity from either vaccination or prior infection. We also have antivirals, such as Paxlovid, which help with preventing the need to be hospitalized.
Although we often like to focus on classifications, such as epidemic/pandemic versus endemic, endemicity does not mean that a condition is benign or without consequences. For example, malaria is endemic to Africa and it kills nearly half a million people every year. In the case of SARS-CoV-2, in 2023, scientists estimated that there was a 20 percent chance over the next two years that we might see another Omicron-like wave. Therefore, we need to remain vigilant. It is important that the nation maintains a robust surveillance system, so that we could quickly identify and address any future variants. In addition, approximately 2,000 people are dying every week from COVID in the US and we are continuing to learn more about long COVID and its consequences. Although we are in a different phase, there are still reasons to remain vigilant.
Being up-to-date with vaccination should be the first line of defense. Vaccination not only decreases the risk of severe disease, but it also prevents long COVID. Recent data show that being boosted also makes a difference. Individuals who are at higher risk for severe COVID-19 should also consider using additional measures to protect themselves, such as limiting time in crowds and wearing a high-quality mask in poorly ventilated indoor settings. Improving indoor air quality with ventilation and filtration decreases the risk of transmission. Testing and antivirals are also helpful. We have learned a lot over the past several years and it is time to use all those lessons to protect everyone in the community.
The Epidemiologist: Millions of Cases, Thousands of Deaths
Eleanor J. Murray, BU School of Public Health assistant professor of epidemiology
COVID remains a major cause of illness and death worldwide. Is it still a pandemic? There are two things to consider in answering this question. First, how widespread does a disease need to be for us to call it a pandemic? The original SARS cases in 2003 met the definition of a pandemic because the virus spread in Asia and in North America, but the size of this pandemic was much smaller. COVID-19 has caused almost 800 million cases of disease worldwide since January 2020, and over 7 million deaths. That’s 100,000 times as many cases as SARS in 2003, and 10,000 times as many deaths; in fact, these numbers are likely underestimated. Right now, COVID cases are still happening widely. In December 2023, the WHO reported 1.2 million COVID cases and 9,575 deaths worldwide. Viewed this way, COVID is definitely still a pandemic.
The answer to our question also relies on how many cases of the disease we normally expect. And this is where governments have flexibility in deciding whether we are in a pandemic. In January 2020, less than 100 cases had ever been reported anywhere. By January 2021, there were 5 million cases per week; in January 2022 and 2023, there were over 20 million cases per week. How many cases we have today in January 2024 is less clear—the end of the emergency has led to a dramatic reduction in testing. The CDC still reports COVID hospitalizations, and, in the week of January 6, 2024, there were about 35,000 hospitalizations due to COVID across the US. By comparison, there were 44,000 hospitalizations at the same time in 2023. These numbers are not very different.
But are these numbers higher than expected or is this just our new normal? The answer to that question is the key to whether we call COVID a pandemic or not. The WHO has ended their public health emergency for COVID, but they still call COVID a pandemic. This reflects their perspective that millions of cases of a relatively new disease every week around the world is not a scenario we should just accept as normal.
All pandemics end eventually. Some, like SARS, end with the rapid elimination of disease. Others, like the plague, end with the disease finally fading into obscurity. Still others, like the 1918 influenza pandemic, see the disease growing milder without disappearing. And some, like smallpox, continue to cause high levels of illness, death, and disability, until we all agree that enough is enough and take action.
With nearly as many hospitalizations in January 2024 as in January 2023, it’s clear that COVID is not growing milder and it’s not fading away. The real question, then, is not whether COVID is still a pandemic, but how much COVID illness and death are we willing to accept?
The Virologist: No Longer New, No Longer Unexpected
John H. Connor, BU Chobanian & Avedisian School of Medicine associate professor of virology, immunology, and microbiology, and National Emerging Infectious Diseases Laboratories researcher
I think the language we use is very important. As a virologist, I use the word pandemic to describe an infectious disease that erupts quickly and puts unexpected pressure on our healthcare system. This is absolutely what we experienced when SARS-CoV-2 spread across the globe in 2020. The emergence was unexpected and there was massive pressure on our healthcare system. The newness of the virus stoked uncertainty and fear. That was then. Now, infection with SARS-CoV-2 is not novel. There is not an unexpected pressure on the healthcare system because of SARS-CoV-2 infection. Infection is still happening all the time. That marks it as endemic. The shift from pandemic to endemic is really marked by time and prevalence. The first SARS-CoV [virus] appeared in 2003 and now has not been seen for decades, so it was a pandemic, but never became endemic. SARS-CoV-2 seems like it is here to stay, right now. That makes it endemic.
I think that people should act the same way they act when trying not to spread flu or other respiratory diseases. If you are really sick, stay away from others. If you know you are sick but not highly symptomatic, distance and masking are polite and helpful. If you know you are going to be around strongly immunocompromised people, being extra careful is a kind thing to do.
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