Is the pandemic over? If only it were so simple

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September 21, 2022 – President Joe Biden says the pandemic is over. The World Health Organization says the the end is in sight. Many of us would rather talk about almost anything else, and even New York has dropped most of its COVID protocols.

Biden’s claim (made to reporter Scott Pelley on Sunday the 60 minutes) has provoked the debate on COVID-19[feminine] explode again, even though he tried twice to soften it. It upset the already divided public, fueled widespread television news coverage and led pundits to take sides.

But for many, a pandemic cannot be declared ‘over’ when the United States alone averages more than 71,000 new cases and more than 400 deaths per day, and there are 500,000 cases and nearly 2,000 deaths each day in the world.

Biden’s comment has divided medical and public health experts. Some strongly disagree that the pandemic is over, pointing out that COVID-19 remains a public health emergency in the United States, that the World Health Organization still considers it a global pandemic and, more importantly yet, that the virus still kills more than 400 people a day. in the USA

Others point out that most of the country is protected by vaccination, infection or a combination, at least for now. They say the time has come to declare the end of the pandemic and recognize what much of society has already decided. The sentiment is perhaps best captured in a controversial new COVID health slogan in New York: “You Do You”.

In fact, a new poll from media site Axios and its partner Ipsos, released on September 13, found that 46% of Americans say they have returned to their pre-pandemic life – the highest percentage since the pandemic began. Meanwhile, 57% say they are still at least somewhat concerned about the virus.

A balance exercise

“How can a country say that the pandemic is over? asked Eric Topol, MD, executive vice president of Scripps Research and editor of Medscape (WebMD’s sister site for healthcare professionals).

It’s far from over, Topol says, and there needs to be a balance between protecting public health and allowing individuals to decide how to run their lives based on their risk tolerance.

“You can’t just drop the audience and say, ‘It’s all up to you. earlier this month.

Topol coined the phrase “COVID surrender” in May when the United States was in the midst of a wave of infections of the BA.2 variant of the coronavirus. He used the phrase again this month after the White House said COVID-19 vaccines would soon become an annual requirement, like the annual flu shot.

Topol now sees hope, tempered by recurring realities. “We’re going down, in terms of the virus circulating,” he says. “We’re going to have a few quiet months, but then we’re going to start again.” He and others monitor emerging variants, including the BA.2.75.2 subvariant, which is more transmissible than BA.5.

The White House acknowledged it in May when he warned up to 100 million infections this fall and the possibility of a significant increase in deaths. The Institute for Health Metrics and Evaluation at the University of Washington predicts that approximately 760,000 people are now infected with COVID-19 in the United States. That number will rise to more than 2.48 million by the end of the year, the group warns.

A new phase?

“From a public health perspective, we’re clearly still in a pandemic,” says Katelyn Jetelina, PhD, a health policy expert who publishes Your Local Epidemiologist, a consumer science newsletter. “The question is, ‘What phase of a pandemic are we in?’ It’s not an emergency, where the Navy ride in boats [as it did to help hospitals cope with the volume of COVID patients in 2020.]”

“The biggest problem with this comment [by Biden] are we normalizing all these deaths? Are we comfortable leaving SARS-CoV-2 as the third leading cause of death? I was disappointed by that comment,” she said.

Even as people shift to an individual decision-making mode from a public health perspective, Jetelina says, most people still need to consider others when determining their COVID-19 precautions. In her personal life, she constantly takes into account the impact of her activities on those around her. For example, she says, “we go to see my grandfather, and everyone does antigen tests first.”

While younger, healthier people can safely relax their protections, they still need to be aware of the people around them who are at greater risk, says Jetelina. “We cannot just put the blame entirely on the vulnerable. Our layers of protection are not perfect.

Like Topol, Jetelina suggests considering the circumstances. She recommends small steps to collectively reduce transmission and protect vulnerable people. “Take off the mask” before entering a high-risk environment and “do the antigen test before going to the nursing home”.

The worst behind us?

“It’s not mission accomplished yet,” says William Schaffner, MD, infectious disease expert and professor of preventive medicine at Vanderbilt University in Nashville. If he could rewrite Biden’s comments, he says, “He could have said something like, ‘The worst is behind us,'” while mentioning the new vaccine to increase enthusiasm for it and committing to keep making progress.

Schaffner also admits that much of society has, at some level, decided the end of the pandemic. “The vast majority of people have taken their masks off, are going to concerts and restaurants again, and they want to function in society,” he says.

He understands this, but suggests that a public health message should be to remind particularly vulnerable people, such as adults over 65 and people with certain illnesses, to continue to take the extra measures, masking and distancing, especially during flu season. at the top.

And public health messaging should remind others of vulnerable members of the population, Schaffner says, so those who continue to wear masks aren’t bullied by those who abandoned them.

A focus on the most vulnerable

Biden’s statement “could have been worded better,” says Paul Offit, MD, an infectious disease expert and director of the Vaccine Education Center at Children’s Hospital of Philadelphia. But, he says, things are different now than at the start of 2020.

“We are in a different place. Today, most of the population is protected against serious diseases [either by vaccination, infection, or a combination].”

The effect of that protection is already showing in the requirements, or lack thereof, says Offit. At the start of the pandemic, “we mandated the COVID vaccine in our hospital [for employees]“Now the hospital will not mandate the new bivalent vaccine.

Going forward, he agreed that the focus should be on the most vulnerable. Beyond that, he says people should make their own decisions based on individual circumstances and their risk tolerance.

An important and looming question, says Offit, is that scientists find out how long people are protected by vaccination and/or prior infection. Protection against hospitalization and serious illness is the goal of vaccination, he says, and is the only reasonable goal, in his opinion, not elimination of the virus.

Biden “is right”

Leana Wen, MD, an emergency physician, professor of health policy at George Washington University and frequent media commentator, takes the opposite view, which says Biden should not backtrack on his comment that the pandemic is over. “He is right.”

She says the United States has entered an endemic phase, as evidenced by social measures – many people are back in school, at work and traveling – as well as political measures, with many places easing or eliminating warrants and other requirements.

There is disagreement, she said, about the scientific measurements. Some say more than 400 deaths a day are still too high to call an endemic pandemic. “We are not going to eradicate the coronavirus; we have to live with, just like HIV, hepatitis and influenza. Just because it’s not a pandemic [in her view] does not mean that the level of illness is acceptable or that COVID is no longer with us.

Wen does not view adopting a public health perspective over a personal perspective as a health choice. “Just because something isn’t a pandemic anymore doesn’t mean we stop caring about it,” she says. But I think [many] people live in the real world. They see that family and friends have come back to play dates, go to restaurants, not wear masks. COVID has become a risk like many other risks they encounter in their lives.

The tension between public health and individual health is ongoing and will not go away, Wen says. And this applies to all health problems. The shift from general public health concern to individual decisions “is what we anticipate and should happen.”

She also noted the cost of COVID measures, including closed schools and businesses and their effect on mental health and the economy, as well as another less discussed cost: the effect on trust in public health

Continuing to demand action against COVID-19 as cases decline, she says, could further weaken trust in public health authorities. New York State having recently declared a public health emergency After finding the polio virus in sewage samples, Wen wondered, “What happens when we say, ‘Get your child vaccinated against polio?’ »

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