Biden Is Wrong, the COVID-19 Pandemic Isn’t Over
Yesterday 60 minutes, in an interview at the auto show in Detroit, Michigan, President Biden stated: “The pandemic is over. Still, we have COVID. We’re still doing a lotta work on it. But the pandemic is over.” His pronouncement caught the U.S. public health community, and even some administration officials, off guard. Scientist commentators scrambled for answers in the following hours to discover the reason he concluded that there wasn’t a pandemic.
Fair play, Boghuma Kabisen Titanji is an Emory infectious disease doctor. said, “the epidemiology and public health text books don’t really say how one determines when a pandemic has ended.” The end of a pandemic is not like a light switch going off. It is not a discrete moment in time, but more of a process—one that can be messy and highly contested. What President Biden’s declaration suggests is that a pandemic’s “end” is not determined solely by science or public health data, but involves social and political considerations.
The classic definition of a pandemic, from John Last’s A Dictionary of Epidemiology, arguably the “Bible” of public health terminology, is: “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people.” By this definition, it would be very difficult to conclude that the COVID-19 pandemic has ended.
Worldwide, there were 481,326 cases of illness and 1,789 deaths yesterday. The World Health Organization still categorizes COVID-19 as a pandemic, although its Director General, Tedros Adhanom Ghebreyesus, said last week that “the end is in sight,” noting that daily deaths worldwide are at their lowest level since the pandemic began.
Maybe President Biden meant the U.S. specifically? But an analysis of last week’s by CBS News found that U.S. COVID-19 deaths were averaging 478 per day, “higher than in July 2021 when the average was 168 deaths per day and also higher than in June 2022 when the average was 258 deaths per day.”
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There are an average 400 to 500 deaths per day notIt would signal an end to the US pandemic. As I’ve argued before, the US cannot eliminate COVID-19 (elimination means there would be no new cases of the disease within our borders). We also cannot drive deaths down to zero, given that there will always be vulnerable people, especially among older Americans, and while our scientific tools for preventing death—vaccines, antivirals, and monoclonal antibodies—are highly effective, they are not 100% effective. However, we can make sure that they don’t die. Can achieve “low endemic levels”—in which there are low levels of severe illness, hospitalization, and deaths, perhaps with seasonal peaks. This is similar to the flu and we aim to maintain low endemic levels through vaccination. The CDC has estimated that flu caused 12,000-52,000 deaths per year in the United States between 2010-2020. We could further reduce this number by increasing access to flu vaccinations each year.
Determining when America has transitioned out of the pandemic phase of COVID-19 to a “low endemic” phase would ideally be done through an inclusive, participatory process. Ole Norheim and colleagues at the University of Bergen, Norway have argued that such a process—involving, for example, hearings, town halls, and citizen panels, “can contribute to more trustworthy and legitimate decisions on difficult ethical questions and political trade-offs during the pandemic and beyond.” There would have been less consternation about President Biden’s 60 minutes interview if he’d brought scientists and the broader public into his deliberations. We don’t know if President Biden ever consulted. His colleagues from the AdministrationHe is determined to end the pandemic, and not just the community.
But the major problem with the President saying the pandemic is “over” is that it could impede our efforts to reach low endemic levels. For example, Congress is less likely to renew funding for COVID-19 measures if the pandemic has “ended.” And the public may hear the message that COVID-19 is “done” and be less likely to get the new bivalent booster—the first vaccine tailored to the current virus variants. The current US burden of illness, hospitalizations, deaths, and Long Covid can and should be driven down before declaring that “the job is done.” There are many ways in which we can achieve this, including tackling the stark inequity in the U.S. and worldwide in access to vaccines, boosters, and antiviral therapies like Paxlovid and Evusheld. To prevent avoidable death, it is extremely important to get boosters to elderly Americans.
We are not yet at low endemic levels—but these are within our grasp. We can declare the pandemic over when we reach that point. We still have much to do before we can declare the pandemic over.
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