How We'll Know When the COVID-19 Crisis Is Really Over

In many ways, American life is returning to normal: Masks are no longer required in many locations, schools and universities are slated to reopen, and the days of social distancing are beginning to fade as concerts and sporting events bring spectators back.

In the U.S., we’re now averaging 154 deaths a day from COVID-19 — a tiny fraction compared to the pandemic’s peak — and some safety measures and restrictions remain in place.  Life hasn’t quite returned to the pre-pandemic status quo, but it feels much closer to it than it did six months ago.

But while we may long for officials to give an all-clear and declare the pandemic history, the health crisis is definitely not over, both in the U.S. and abroad.

The question of when the crisis will actually be over is a layered one — with different answers from a local, national and global perspective.

No Set-in-Stone Metrics for When it’s Over

The U.S. declared COVID-19 a national emergency on March 13, 2020.

After many months in which the U.S. led the world in coronavirus cases, the virus is now under much better control here, due to the widespread availability of COVID-19 vaccines.

That federal emergency status is still in effect — it has been renewed several times, most recently in April — and can be extended by the secretary of the Department of Health and Human Services for as long as deemed necessary.

It’s not clear whether the U.S. Centers for Disease Control and Prevention will issue any sort of all-clear. The CDC did not respond to NPR on the matter.

Ali Mokdad, an epidemiologist at the University of Washington, who spent nearly 20 years at the CDC, hopes the agency will eventually give Americans that long-awaited green light.

When the time comes, Mokdad told NPR, “It’s very important for our own CDC … to say, ‘We’re out of danger right now. We should move on with our lives.’ ”

He says there aren’t set-in-stone metrics to determine when a pandemic is over, because the situation is dynamic and changing so fast. And the virus itself is evolving, too.

“When you look at the genetic makeup and sequencing of the virus … and how it has been changing, there’s still a lot of room for it to mutate. It’s not at the end of the mutation cycle that it can do. So that virus could still carry a lot of surprises,” he said.

How a Pandemic Officially Ends

The World Health Organization declared COVID-19 a pandemic on March 11 last year – the same day that life began to change dramatically in much of the U.S.

So when the virus eventually is under control, will WHO declare the pandemic over?

Basically, yes.

“In general, if the worldwide spread of a disease is brought under control to a localized area, we can say that it is no longer a pandemic, but instead, an epidemic,” a WHO spokesperson told NPR.

But the official emphasized that the characterization of the outbreak as a pandemic has no formal meaning under international law.

What does have a formal meaning is a “public health emergency of international concern” – a status assigned to COVID-19 at the end of January 2020. That’s the highest level of health alarm under international law.

WHO convenes an international committee every three months to determine if an outbreak should still be considered such a global health emergency. And when it’s over, WHO says it’s over. That’s what it did last summer regarding an Ebola outbreak in Africa.

But it will most likely be a while before that happens.

As WHO Director-General Tedros Adhanom Ghebreyesus frequently states: None of us will be safe until everyone is safe.

Not Out of the Woods Yet

The delta variant has spread just as fast through the U.S. as epidemiologists feared it would. It now accounts for more than half the cases in the U.S., and far more than that in certain states.

Lynn Goldman, an epidemiologist and dean at the George Washington University School of Public Health, says the U.S. has some things working for it, and some against it.

The good news is we’ve shown the ability to lower rates of transmission and deaths from the virus. And of course, Americans have widespread access to COVID-19 vaccines.

The bad news, she says, is there’s resistance to the two main ways to prevent transmission — getting vaccinated and wearing a mask.

“And unfortunately, those two attributes tend to coincide within the same people and within the same population subgroups,” Goldman said.

In other words, many of the same people who don’t want to get a vaccine also don’t want to wear a mask.

As a result, Goldman says, we’re likely to see continued transmission of the virus in the U.S., concentrated in the areas with the lowest rates of vaccination.

The current vaccines are highly effective against COVID-19, including the delta variant. That means vastly different outcomes for those who are vaccinated and those who aren’t. Last month, for example, 92 people died of COVID-19 in the state of Maryland. All of them were unvaccinated.

Local Numbers Can Be Most Informative

The most precise indicators of progress or problems can be found on a very local level.

National and even state-level metrics for infection or vaccination rates can be misleading, Mokdad says. A state’s overall vaccination rate can disguise much lower numbers in certain geographic pockets that remain highly vulnerable to outbreaks.

Low vaccination rates make it easier for fast-spreading variants to take hold.

While there are many ways to track progress (or lack thereof) in controlling the virus, Mokdad says one especially useful metric is hospitalizations.

“There is no way to make a mistake or underreport hospitalization for COVID-19, because everybody who goes to a hospital right now is being tested for COVID-19,” he said.

That stands in contrast to cases, which can go uncounted due to a lack of testing, and the number of deaths, which can spike weeks after other indicators during an outbreak.

Coronavirus Will Likely Spike Again This Winter

Even though U.S. cases are much improved from the peak, health officials say unvaccinated people are likely to continue to die from COVID-19 until we successfully control transmission.

Experts say the next big challenge will come this winter, when another wave is expected as people move inside during colder months. There will also likely be some outbreaks as students go back to school — children under 12 are not yet eligible for the vaccines.

How dangerous the virus continues to be will depend on vaccination levels of the population and the lethality of the variant circulating when winter comes. How quickly a state or local government is willing to go back into restrictive measures — like wearing masks indoors — will play a role, too.

“For the short term, it will be seasonal, like what we see with the flu, simply because we don’t have enough vaccine to vaccinate everybody in the world,” Mokdad said.

If we do the right things like increasing production of the vaccine, he says, it’s possible we eventually won’t have to worry about COVID-19 anymore.

What the End of the Crisis Might Look Like in the U.S.

Goldman sees two possible scenarios for the U.S. in the near future.

One is that the virus evolves to more readily evade the vaccines that have been administered.

If that happens, she says, “then we’ll have to go into a whole other round of re-vaccinating everybody.” Drugmakers are already working on booster shots in case they become necessary.

On the other hand, the current vaccines could continue to be highly effective.

In that case, Goldman believes that within the next several months “we’ll see near elimination of the pandemic, certainly in the United States and Europe, other wealthy countries, Japan, Taiwan,” while efforts will continue to immunize people in the rest of the world.

But it’s very likely, Goldman says, that even when we can say the pandemic is over, transmission will continue in parts of the country that have low rates of vaccination.

But one thing is clear: No matter what happens, the effects of the pandemic — including long-term physical and mental health issues, and economic fallout — won’t end when the official emergency does.

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