I’ve written before about what the future of Covid-19 will look like once the virus moves from being a global pandemic to an endemic disease. The most recent time I did so was this previous May, when Covid had just been declared to be exiting the pandemic stage. So with people and governments starting to treat Covid-19 as no longer a threat, I thought it was time for an update about what risks Covid could still pose and what policies are being enacted to combat these risks.
Is The Pandemic Over?
In a recent interview, U.S. President Joe Biden stated that the Covid-19 pandemic was officially over. This immediately drew criticism from scientists and health experts for being extremely misleading if not outright untrue. And while this statement is largely semantic and hasn’t been linked with any official policy changes from the Biden Administration, Covid-19 is still considered a public health emergency. Given the current status of the virus, this statement reflects a public attitude more than a scientific perspective. Everyone wants the pandemic to end, but viruses rarely respond to public opinion. There is no standard definition of a pandemic as it relates to public health. We could define a pandemic as having ended when its death toll falls too low to affect an area’s average mortality rate, or when the disease no longer affects the average person’s life. But Covid-19 will continue to have small, seasonal resurgences similar to flu, which would arguably make it an ongoing pandemic by this definition. Any hard definition of pandemic will have a lot of gray area, which does make talking about an end to the pandemic fraught.
With that disclaimer out of the way, is the current infection rate of Covid-19 at a point where it will no longer cause mass death, hospital overcrowding, and regular risk to vulnerable people? Short answer; no. For the past few months, the number of deaths in the United States has hovered around 10% higher than what would be expected for this time of year, this 10% almost certainly being the result of Covid cases. This is down from a 40% higher death rate at the pandemic’s height, but it’s not nothing. The current average in the United States is roughly 40,000 new Covid infections and roughly 300 Covid deaths per day. This is comparable to the number of daily infections and deaths from flu at the height of flu season, which means the daily average of Covid deaths, for the past few months and for the foreseeable future, has been equivalent to the number of people who die per day of flu during the worst few weeks of flu season.
Graph of Covid daily deaths in the United States. Notice the average death rate presently is still slightly higher than in the middle of 2021 and the small uptick in deaths near the present. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/past-reports/07152022.html
Speaking of flu season, I’ve mentioned a few times how Covid will become the new flu; having seasonal flare ups that while far more manageable than it was during the pandemic’s height, could still present some challenges for our healthcare infrastructure to handle. Why flu has this seasonal nature isn’t well understood, but theories include cold weather preserving viruses, cold air drying out human mucus membranes and making us more susceptible to sinus infection, less UV radiation sterilizing viruses in the air, and people indoors more often which increases rate of transmission. Whatever the reason or combination of reasons, it’s likely Covid will flare up at the same times of year as the flu. Add to this the fact that more people will be traveling than normal due to the winter holidays, and experts are predicting a surge of Covid cases in the coming months. Wastewater surveillance systems in parts of the Northeastern United States have already noted an uptick in viral levels and multiple nations in Europe are experiencing a pronounced spike in Covid cases in recent weeks. A good predictor of upcoming infection rates in North America has been current infection rates in Europe; the amount of traffic between the continents mean diseases move between them easily while Europe’s colder climate and higher population density mean it tends to see disease spikes earlier. And there is of course the concern of new Covid variants and what role they play in this spike in cases. New strains of Omicron have been observed that seem to be resistant to the immune reactions created by older Covid strains. It’s too early to tell if these new strains will play a significant role in the upcoming season, but an uptick in cases will be significant regardless of what strains are present.
I don’t want to overly play-up or play-down the risks of this uptick in cases. While a surge in Covid cases is likely on its way, it currently can’t be predicted how severe this surge will be. Only time will tell how severe this upcoming ‘Covid season’ will be and it will provide useful data for what future ‘Covid seasons’ will be like. But with hospitals in parts of the world still overtaxed by the current number of cases and by the backlog of patients with other diseases who had to delay treatment during the pandemic, any surge can be a problem. The best way to mitigate against this surge will be with vaccination. The newest vaccines are bivalent, meaning they vaccinate against the original Covid strain and the Omicron strain in one dose. They’ve been shown to prevent infection in 93.2% of cases. Worst case scenario, these vaccines can be the difference between a mild case of covid and illness requiring hospitalization. If you haven’t gotten your bivalent booster yet, now is the time in preparation for the winter and holiday season.
Other Diseases Post-Pandemic
You may have already heard that this upcoming flu season is expected to be a bad one after two years of relatively mild flu. Quarantining against Covid was also effective against other transmissible diseases, but now that quarantines are ending, flu appears to be coming back with a vengeance. Hospitalizations due to influenza have been higher than normal even before flu season, with the number of flu-related hospitalizations in May of 2022 being the highest in five years for that time of year. Some of this is due to a lack of data for forecasting; I’ve talked before about how preparing seasonal flu vaccines requires the ability to predict what flu strains will be most common that year using techniques similar to weather forecasting. Due to the mild flu seasons caused by the pandemic, there is less data to use for predicting what strains will be common this year.
Graph of flu outpatient visits over seven years. Notice how the 20-21 season and the 21-22 season have had the highest rates of flu during non-flu season of all the years measured. https://www.cdc.gov/flu/weekly/index.htm
But this can’t be the entire cause of the problem because flu is not th
e only disease to be surging. The recent epidemic of monkeypox may or may not be related to the decline of Covid-19, but if it was related it would fit a pattern. Respiratory syncytial virus (RSV) had an uptick this past summer, despite it being seasonal to the winter. Over a thousand children in 2022 experienced hepatitis-like symptoms, the majority of cases were linked to Human Adenovirus 41, a virus that normally causes gastroenteritis in young children in the developing world. Upticks in multiple diseases, some at different times of year or with more severe symptoms than normal is noteworthy, particularly after a pandemic. This all points to the possibility that two years of quarantine have weakened our immune systems. How exactly this works on a biological level is not well understood by scientists. It could be that new strains of certain viruses that were contained by the quarantine could now be able to infect more people. Our antibody responses to pathogens normally downregulate when we aren’t exposed to those pathogens, so it’s possible these responses have gotten too low by a lack of exposure. This phenomenon has been most noteworthy in young children, possibly due to their immune systems actively developing and that the pandemic represents a wider portion of their lives up to this point.
Whatever the exact cause and mechanism, this is not as big of a problem as it sounds. None of these new outbreaks are anywhere near as severe, widespread, or lethal as Covid-19 and experts agree they will die back down within a year or so. These upticks in other viruses are like being blinded by light immediately after leaving a dark room; a temporary effect of a lack of exposure. If and how these upticks should impact the end of quarantine orders is debatable as we still don’t fully understand how this phenomenon works and what we could do to prevent future post-pandemic upticks in unrelated diseases. But It does provide the potential for insight into how our immune systems work and how they are affected by pathogen exposure and the lack thereof. Hopefully, this data could be useful during the next pandemic.
While the pandemic…could be said to be over, or at least in its epilogue, its aftershocks will continue to be felt for a while. SARS-CoV-2 will remain in humanity’s viral ecosystem indefinitely and we will continue to struggle with it until we understand it as well as we understand other pathogens. As of writing, we are still seeing 1,200 Covid deaths and over 400,000 new Covid infections a day globally and that pattern will continue for the foreseeable future. So it is important that, in our desire to feel a sense of normalcy once more, we do not become numb to Covid. We can’t rush a disease, no matter how tired we are of it. Remember to get your booster, continue to wear masks in certain situations, keep up to date with what health agencies recommend, and that we aren’t truly safe until everyone is safe.
Comments