I sometimes think back to a phone call with a friend in the spring of 2020. Cases were down and pundits were optimistic: it seemed genuinely possible that, by mid-summer, all this would finally be over. These last two months, I said to my friend—will they seem, from summer’s vantage, like a weird dream? When, three months hence, the bars were thronged and the mask factories wound down, what would we do with the memory of spring? To which my friend said something like: who knows, hard to say. And then we talked about something else. And then the pandemic continued for another eighteen months. And now here we are, and it’s still the pandemic, and while things are infinitely better than they were a year ago, the fact is that we’re still wearing masks on the subway. So: when, exactly, can we definitely claim to’ve licked this thing? What metrics, what facts on the ground, will determine when we can fully return to normal? For this week’s Giz Asks, we reached out to a number of experts to find out.
Associate Professor, Epidemiology, University of Michigan
The uncertainty is really too large to put any kind of specific date on it, although it’s pretty clear that we still have a long way to go. In terms of how it ends—as much as I would love to see us reach “COVID zero”, at this point I would expect we’re headed toward endemic, probably seasonal transmission, where most people have been vaccinated or have some degree of immunity due to previous infection and so infections tend to be less severe. This makes sticking with prevention strategies like masking and getting vaccinated (and expanding global vaccine access!) so important to reducing transmission and strain on healthcare systems, to minimize the toll of deaths and severe outcomes incurred on the way to Covid-19 becoming endemic.
When it comes to criteria, I’d expect the pandemic to be thought of as “over” when cases, hospitalizations, and deaths due to Covid-19 are consistently down to relatively low, manageable levels. In terms of numbers, it will probably vary from country to country, but one might see something similar to what we would normally see from flu, which causes an estimated 12,000-61,000 deaths per year in the US (compared to the 375,000 deaths caused by COVID-19 in the US in 2020, and around 295,000 more so far in 2021).
It’s important to underscore that different places will probably reach the end of the pandemic at different times (based on vaccine access/uptake, social distancing and other mitigation measures, etc.), and that even when the pandemic is “over”, we will still have to grapple with many of its longer term effects—whether that’s Long Covid, mental health impacts, issues of misinformation and mistrust, or economic aftereffects.
Emergency Physician and Public Health Professor at George Washington University, and the author of Lifelines: A Doctor’s Journey in the Fight for Public Health
I don’t think we, as a society, have defined what it would mean for the pandemic to be over. Will it be ‘over’ when there are no more cases of Covid-19? Will it be ‘over’ when the levels of hospitalization are such that we no longer worry about overwhelming our healthcare system? Will it be ‘over’ when the number of deaths falls below a certain number? Regardless, I think most people would agree that we are nowhere near the threshold below which Covid-19, the worst public health crisis of our lifetimes, is no longer an urgent concern. I don’t think we’re going to attain that level of stability any time soon. Certainly, it’s not going to happen while young children are still ineligible for the vaccine; nor while, around the world there are many, including the most vulnerable among us, who do not have access to the vaccine. At some point, we will have to reach a new understanding of what it might mean for this pandemic to reach a steady state, where it’s no longer top of mind in every one of our decisions. But we’re nowhere near that point now.
Senior Scholar at the Johns Hopkins Center for Health Security whose expertise is in infectious diseases, critical care (ICU) and emergency medicine
That pandemic will be over in a global sense when most nations of the world are able to treat Covid-19 like other respiratory viruses they deal with year in and year out. SARS-CoV2 is an efficiently spreading respiratory virus with a wide spectrum of symptoms that circulates in an animal host—it cannot be eliminated or eradicated. The goal is to remove its ability to cause widespread levels of severe disease, hospitalization, and death. This is best achieved by vaccinating those at highest risk for complications so cases are decoupled from hospitalizations but there will always be a baseline level of cases, deaths, and hospitalizations. Natural immunity post-infection also plays a significant role as well but is not the optimal way to tame the virus. The pandemic will eventually transition to a state of endemicity and the post-pandemic world will be one in which Covid-19 still exists but in a much more manageable setting.
Professor and Chair of Epidemiology at UC Berkeley
The honest answer is that no one can know for certain, partly because of the unknown future regarding variants that can escape vaccine-induced protection, and partly because it remains unclear when we will get a higher proportion of the world’s population vaccinated. But the future is most likely one in which SARS-CoV-2 regularly circulates in the human population and becomes more of an endemic infection/disease, with perhaps a seasonal pattern a la influenza. I think that scenario won’t be with us for at least another 12-18 months.
Dean of the Milken Institute School of Public Health and Professor of Environmental and Occupational Health at George Washington University
The job of producing enough vaccine, and getting it into everybody’s arms, while outpacing the virus’ ability to mutate—it’s not a quick one. I think it will be at least a year until the pandemic ends, and that’s being extremely optimistic. The inequities involved in vaccine production, and the degree of resistance we’re seeing to vaccination, means it could be a couple of years before this actually concludes.
It’s humbling. In the first place, our knowledge of coronaviruses simply wasn’t as good as it should have been. We did not predict how rapidly this could mutate. Meanwhile, our knowledge of human behavior was, as we’re learning, imperfect. We did not foresee the levels of miscommunication we’d be faced with, nor the lack of scientific literacy. People know that some of the vaccines use mRNA but if you don’t know enough about genetics or the science involved that can just end up being scary rather than reassuring. People start going off onto tangents—“well, what does that do to you?”—without understanding how genetics work. It’s understandable to me that people have those concerns or fears, but this is leading to a tremendous amount of vaccine hesitancy. That is too bad because the science tells us that mRNA doesn’t alter the body’s DNA in any way.
Then of course there’s the problem with developing a vaccine for children, which has turned out to be more daunting than I, as a pediatrician, ever thought it could be. The virus is still circulating among kids, and that’s keeping this pandemic alive, because as long as kids are circulating the virus, we’re going to see more breakthrough infections in the adults around them.
We’ll know this pandemic is over when we’re no longer observing excessive rates of death due to Covid on a daily basis—in the whole world, not just the US. The one thing we know is that this pandemic will not be over as long as Covid is circulating somewhere in the world. That doesn’t mean we have to eliminate every case. What we might end up with is a situation where—through immunity of the population, or mutation, or (more likely) both—the virus ends up being more like the cold or the annual influenza, where we certainly have to pay attention to it, perhaps as a seasonal transmission every winter, and have to vaccinate people every year, but we no longer have these very high rates of mortality.
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