Is the COVID-19 pandemic over?

After more than two and a half years of COVID-19 restrictions and mandates, many people are yearning for an official nod that marks the pandemic’s end. Many people could conclude that we have finally reached this point by watching the news last week.

World Health Organization Director-General Tedros Adhanom Ghebreyesus told reporters at a press conference that the end of the pandemic is in sight. A few days later, United States President Joe Biden declared during an interview on 60 Minutes, “The pandemic is over.” But he also acknowledged, “We still have a problem with COVID. We’re still doing a lot of work on it.”

A pandemic is a disease outbreak spanning several countries that affects many people. The WHO is responsible to declare when an outbreak has become a pandemic, and when it ceases to be a public health emergency of international concern. Worldwide, COVID-19 is still causing nearly 1,600 deaths each day and case numbers haven’t plateaued at a low level, leading WHO’s chief scientist, Soumya Swaminathan, to conclude, “It’s still a little premature to say that we’re over it.”

In the U.S. the virus is killing between 400 and 500 people daily. Jennifer Nuzzo, an epidemiologist at Brown University’s Pandemic Centre, says that “that’s still too many.” Others agree with Nuzzo. They also say that declaring the end to the pandemic could compromise ongoing testing and vaccination efforts. Omicron BA.5 is still highly contagious and continues to circulate in the U.S., as well as in many other parts of the globe. Also, as people gather indoors in cooler temperatures, the possibility of more cases.

Complicating matters, say some epidemiologists, is that there aren’t established criteria–an acceptable level of cases and deaths, for example–to use to determine whether the pandemic is over. While it’s true that humans are more resistant to SARS-CoV-2–through vaccination and or COVID-19 infection–says Eric Topol, founder and director of Scripps Research Translational Institute in California, “the virus is still ahead of us.” To him, the end of the pandemic isn’t imminent, and “that’s for sure.”

What factors tell us when the pandemic is over

While the number of daily deaths is one metric to gauge whether the pandemic is coming to an end, others include case numbers, seasonality of outbreaks, vaccination rates, availability of effective treatments, and the transmissibility of current and new COVID-19 variants. Swaminathan warns that drawing such conclusions is difficult. “This is a new virus, and we haven’t had a global coronavirus pandemic before.”

Another confounding element is the lack of data from many countries, she says. Figuring out when the pandemic shifts from its acute phase to an endemic one, meaning that COVID-19 is still around but not causing large outbreaks, might only be able to be determined retrospectively. “We may be able to look back and say it was the summer of 2023, for example, that the world came out of the effects of the pandemic.”

For Topol, that judgment has to be based on the trajectory of the pandemic. “I look at where we were in summer 2021–we were down to 12,000 [daily] cases in the U.S. and deaths were just over 200,” he says. Topol claims that if they held on, he would be happy to declare the pandemic phase over. “But we are nowhere near that.” Topol fears that new variants could cause more cases and hospitalizations, allowing the pandemic to continue.

To Lone Simonsen (an epidemiologist at Roskilde University, Denmark), the seasonality of the outbreaks and fewer deaths could help to indicate when the pandemic might be over. She says that if the number of cases rises in the summer, when the virus has fewer chances to spread, it could indicate that the pandemic phase is still underway. That was the case in 2021, when cases were driven by the Delta variant and this past summer with Omicron. Simonsen is waiting to see what happens.

But Denmark and other European countries with high levels of vaccination scrapped most pandemic mandates and restrictions months ago, as COVID-19 hasn’t been causing severe illness or overwhelming hospitals. Simonsen said that COVID-2022 is still a concern.

Amesh Adalja, an infectious disease specialist at the Johns Hopkins Center for Health Security argues that the global pandemic phase is largely over given that hundreds of millions of people have already been infected by the virus, there are vaccines and treatments that can prevent severe illness, and COVID-19 is unlikely to completely disrupt the healthcare system like it once did. “It doesn’t mean all of a sudden things go back to 2019. It doesn’t mean that COVID-19 disappears, and all action stops,” he says. “It means there is going to be a baseline number of cases, hospitalizations, and deaths.”

What those acceptable levels of hospitalizations and deaths may be is a political decision, says David Heymann, an infectious disease epidemiologist at the London School of Hygiene and Tropical Medicine and former head of WHO’s communicable diseases cluster.

Saying it is over when it isn’t

Nuzzo and others worry that statements like the pandemic is over may be a disservice. Nuzzo states that the U.S. has now introduced an Omicron-specific booster. He fears that this will send a message to millions of Americans who may be at risk of serious illness and may not need to be boosted. “That’s really, really unfortunate.” (See 6 big questions about the new Omicron-targeting booster answered. )

She is also concerned that such statements may lead to a greater reduction in access to free COVID-19 testing and treatments, especially for those uninsured.

Topol worries that it could also undermine the motivation and funding to ramp up development of better COVID-19 vaccines and treatments, jeopardizing the health of millions who are immunocompromised or at the risk of developing long COVID. He says this is not the time to make bold statements about the end of the pandemic. “But it’s time to be bold about accelerating to a point where we look to say, we nailed it, we did it.”