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
March 4, 2024
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- Jessica Colarossi
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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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Jessica Colarossi
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Jessica Colarossiis a science writer for The Brink. She graduated with a BS in journalism from Emerson College in 2016, with focuses on environmental studies and publishing. While a student, she interned at ThinkProgress in Washington, D.C., where she wrote over 30 stories, most of them relating to climate change, coral reefs, and women’s health.Profile
Boston University moderates comments to facilitate an informed, substantive, civil conversation. Abusive, profane, self-promotional, misleading, incoherent or off-topic comments will be rejected. Moderators are staffed during regular business hours (EST) and can only accept comments written in English. Statistics or facts must include a citation or a link to the citation.
There are 16 comments on Is COVID-19 Still a Pandemic?
I’d like to offer a correction: vaccination does not “prevent long covid” but it may decrease the chances of long covid. The only way to absolutely prevent long covid – is not to catch covid.
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Agree with L Pederson. It is misleading to say vaccination prevents long Covid, when in fact, it only reduces the risk. Reinfection greatly increases the risk of long Covid, underscoring the vascular, endothelial disrupting, immune dysregulating nature of this airborne BSL3 pathogen. There is no robust or durable “population immunity” to a virus that continually mutates, outpacing vaccines and treatments. Evusheld and ALL monoclonal antibody treatments are no longer authorized for this reason. Of the three commentors, Professor Murray makes the most comprehensive sense. Bottom line: it’s airborne. To stop transmission, don’t share air: always wear a well-fitted respirator mask indoors with others or in close proximity outdoors. improve ventilation, stay home when sick until asymptomatic AND testing negative at least twice, at least 24 hours apart, take Paxlovid if you can get it, and keep up with vaccinations. In. That. Order.
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Thank you, L. Pederson! I came here to say the same.
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“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.”
This has nothing to do with being kind or polite and completely ignores asymptomatic transmission.
As expressed by both Prof. Assoumou and Prof. Murray, the amount of COVID deaths and Long COVID should not just be accepted as the new normal.This means that we need to try to limit the spread of COVID. And this is done by wearing well-fitted high-quality masks and turning on the air filters in BU classrooms for example (and not turning them off again, as some professors do..).
If you know you are sick you shouldn’t expose others to your pathogens. This should not be controversial.
It is truly remarkable that the simple concepts of asymptomatic transmission and transmission chains seem to still not be understood by some people after four pandemic years. For example, if you feel fine (asymptomatic) and you are among people that you think are not immunocompromised, then you can still give a pathogen to these “lucky people”. These lucky people, who might still develop Long COVID can then in turn infect an immunocompromised person (asymptomatically), whose potential more serious outcome could have been prevented.
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Where is the self-reflection and detailed analysis of what worked and what didn’t? I hope the public will never again trust the so-called experts and media, who are more interested in dogma and self-promotion than in serving the public interest.
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Thank you for your comment. In fact there has been incredibly deep scientific study around the world of what worked and what did not work. It’s all publicly available. When you say, “never again trust the experts,” I am curious about one thing: Were the 1.2 million people who died from COVID merely a mirage, “self promotion” in your words of something nefarious? And those people actually did not die from COVID? — The editors
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Thank you, Doug,
To quote me correctly, I used the term “so-called experts.”
There are real experts and those who believe they are or want to be experts.
There are objective media and propaganda tubes.
Yes, there are studies from multiple countries covering different angles of COVID response; you did not quote any, so below is one of them:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10399217/
“In conclusion, Sweden experienced relatively fewer deaths per population unit than most other high-income countries that implemented stricter lockdown measures. It is concerning that some scientists who advocated for stringent measures seem to disregard real-world data and cling to their version of reality. The ability to learn from mistakes and acknowledge that hypotheses may be wrong is essential for future pandemic preparedness. This, coupled with careful analysis, is crucial for developing effective strategies in the face of future outbreaks.”
Do people believe that the media, including BU Today, served the public well during the Pandemic?
I would love to see the current opinion survey on that subject.Reply
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Yes. Sweden’s story is well documented. It also was not perfect–by a long shot. Essentially they sacrificed old people for young people: “In late 2020, the Corona Commission, an independent committee appointed by the government to evaluate the Swedish pandemic response, found leaders had largely failed in their ambition to protect the elderly, noted Frans at The Conversation. At that time, almost 90% of those who had died with Covid in Sweden were 70 or older.” So my point is that it’s very easy now to play Monday Morning Quarterback and say, everything should have been handled differently and blame “so-called experts.” But reality is that in the moment, when an actual, deadly, airborne disease was circulating and scientists were frantically trying to learn more about it, a more cautious and protective approach was taken. And yet still 1.2 million people died. So you are saying it was far too strict and draconian. Perhaps. And do I wish schools had remained open? Absolutely. But that’s easy to say now. Just to be clear, you are saying that you would have been fine then if 2 or 3 million people died instead. There is a reason hindsight is 20-20.
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In support of my previous reply (not posted by BU Today).
https://www.wsj.com/articles/covid-lessons-learned-four-years-later-596a9fa9?mod=opinion_lead_pos5.
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In the article, it said that WHO estimates about 10,000 died in December, 2023 throughout the World. Annualizing that gives us 120,000 worldwide. In a typical flu season between 40,000-50,000 Americans die per year. In a bad season, the number can be twice that. It sure sounds like the risk is much less than the flu.
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I think maintaining a balance between personal responsibility, vaccination, and considering others’ safety is crucial as we continue navigating through this uncertain terrain. And hey, if wearing a mask in certain situations can help protect those around me, I’m all for it.
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Covid never went away it’s still here and affecting lives.
Unfortunately, due to the misinformation received during the pandemic, no one wanted to believe they could get sick from others or that the air could be catageious.
The real issue is the negativity surrounding the nation from states who refused to adjust to the mandates for selfish reasons and media that did not offer legitimate covid information.Reply
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I agree. I also agree that proper precautions sho
uld still be exercised.Reply
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I just left the hospital with covid. Doctors would not give me paxlovid because the new variant is milder and the mortality rate is much lower. As of April 2024, the mortality rate is 3 per 100,000. At it’s peak, the mortality rate was 297 per 100,000.
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I think the situation is very complex from here. The virus is still around and spreading. Herd immunity to COVID-19 has been proven nearly impossible. It has also been proven that people can get COVID-19 more than once. Vaccines do not sterilize the virus but reduce the severity of virus symptoms.
On the other hand, the public appears to be done on a large scale with masks, social distancing, business closures, school closures, lockdowns, stay-at-home orders, and long quarantines on travel. So as the result, we have reached the “social ending”phase of the pandemic, where the public decided to move on with their lives even though the virus is still out there.
The sad part is that people is that people are still getting sick of the virus and dying of it everyday. It is a lesser amount than at the beginning, partially due to the fact that we have developed vaccines and therapeutics for treating it. But the sad part is the viruses characteristics make it very difficult to eradicate. Unlike Measles and Chicken Pox where most people get once and have long term immunity to, COVID-19 only provides a few months of immunity after infection, and it mutates its spike protein which makes it hard to eradicate with vaccines long term.
Adding more fuel to the COVID-19 fire, the virus has animal reservoirs in over 32 other species and some of these animals such as deer, big cats, hyenas, and otters are wild, not captive. Even worse, they have found old variants such as Alpha, Beta, Delta, and Gamma still present in Deer.
So it is possible to eradicate COVID-19 and declare the pandemic over or has COVID-19 became hyper endemic and will be a virus that like colds and flu we will be living with going forward? It is difficult to predict the future, but the evidence is pointing to the sad fact that COVID-19 will be hyper endemic.
I would not rule out the potential of a medial ending (eradication) with better vaccines and therapeutics or going back to quarantine, masks, and social distancing of he entire population but achieving a medical ending seems unlikely. Some of the public health restrictions were fought with lobbying, defiance, protests, lawsuits, legislation, and others. After a year and a half of public health measures and quarantines, the public choose to move on and gave up on the restrictions and resumed their lives, accepting the risk of COVID-19. Eventually schools, offices, stadiums, performing arts theaters, restaurants, bars, zoos, amusem*nt parks, and the like were reopened. The same with quarantine free international travel. The public did seem to share a uniform goal of trying to eliminate the virus with behavior change, giving up their social lives, homeschoooling, working from home, and isolating as much as possible. The sad part is this implicates the immunocompromised and makes some of their ordinary day to day actions high risk. I think going back to lockdowns for COVID-19 would be a political nightmare and may be impossible due to court decisions and legislation that was passed outlawing restrictions in some areas.
In reality, Humanity must accept an imperfect outcome.
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So.. why is the Biden administration allowing tens of millions of unvaccinated illegal immigrants into the US with essentially zero border process? Especially when all of the liberal states just locked down everything for years because of the supposed “risk” of getting a minor flu (covid). Liberals are so inconsistent it’s obscene.
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