The quick answer is yes, we are still living in a pandemic. A pandemic refers to a disease that has spread to several regions around the world, and COVID-19 continues to have sustained transmission around the world.
Over the past few months several hundred people have died each day in the United States from COVID-19. It’s been the third leading cause of death in the United States the for the past two years and will likely remain in that position (behind heart disease and cancer) again in 2022.
But we are in a far better place than we’ve been at any time during the pandemic. Before we evaluate some of those factors, let’s look at some definitions and take a glance at pandemics through history.
- Endemic means a disease is consistently present within a given geographic area or population. Without actions such as vaccinations or changes in behavior the disease may remain at this level indefinitely.
“Chickenpox (varicella) is an example of an endemic disease. It’s always around, and we can roughly predict how many children will get chickenpox each year,” said Tom Jeanne, M.D., M.P.H., deputy state health officer and deputy state epidemiologist. “Before vaccination began in 1996, about 4 million people got chickenpox and 100 died each year; 15 years after vaccination began those numbers have dropped by over 90%, but the disease is still endemic at low levels.” - An epidemic occurs when a disease spreads more than is normally expected in a population for a duration of time. Such an event may also be called an outbreak; the term epidemic is typically used for large outbreaks, often occurring over long time periods. A disease does not need to be infectious to be an epidemic. Obesity or diabetes are examples of epidemics in the United States.
“An example of an infectious disease epidemic is the cholera outbreak that occurred in Haiti after a catastrophic earthquake in 2010, which grew to more than 820,000 cases and, tragically, nearly 10,000 deaths,” Dr. Jeanne said. - A pandemic is similar to an epidemic, but it affects a larger area and more people in multiple countries or continents. COVID-19 still fits this description.
Some of the more notable pandemics in history
- The Black Death was a bubonic plague pandemic from 1346-1353 that killed at least 25 million people around the world. This illness is caused by the bacterium Yersinia pestis, which can be passed to humans by fleas or rodents. The plague still exists today but can be treated by antibiotics.
- Smallpox is thought to have started spreading at least 3,000 years ago. It killed three in 10 people who become infected with it, and it is responsible for numerous endemics and pandemics throughout human history. When Europeans carried smallpox to the Americas in the 15th and 16th centuries, it decimated Indigenous populations. And in the 20th century, smallpox killed an estimated 300 million people around the world. Following a massive global vaccination campaign, smallpox became the first and only human infectious disease to be eradicated. There has not been a case of smallpox identified anywhere in the world since 1977.
- Influenza caused three global pandemics in the 20th century. The most notorious was the 1918 pandemic, which killed an estimated 50 million people around the world (675,000 in the United States), making it the most severe pandemic in recent history. The 1918 flu pandemic, which came in four waves over the course of two years, had a higher mortality rate than the COVID-19 pandemic, despite being caused by a virus that was less contagious. The pandemic’s mortality rate likely would have been lower if a vaccine or modern antibiotics were available, as many people infected with the 1918 flu virus developed secondary bacterial infections that were often fatal.
- HIV/AIDS is thought to have jumped from chimpanzees to humans in central Africa in the late 19th or early 20th century, but the disease spread undetected for decades until it was identified in 1981. HIV (human immunodeficiency virus) has an incubation period that lasts for years. This means infected individuals can spread HIV without knowing they are sick. It may take up to a decade or longer, often far sooner, for HIV to progress into AIDS, but once the disease reaches this stage the fatality rate is 100% without treatment. With the development of highly effective treatments, some experts consider HIV/AIDS endemic today, rather than a pandemic. Additionally, once the treatment lowers the viral load of a person living with HIV to be undetectable, they can no longer transmit the disease to others.
A common theme in all of these pandemics is that marginalized communities suffered the greatest losses. The burdens of disease are not borne equally, heightening the inequalities that already exist in a society. We have seen our communities of color and our Tribal neighbors be disproportionately affected by COVID-19 due to systemic racism and bias. While we have seen gaps closing around COVID-19 immunization rates, the gaps still exist for booster doses.
Another theme among pandemics is that their statuses can change. A pandemic may end by eradication, as in smallpox, or by transition into an endemic disease as its prevalence diminishes. A disease that becomes endemic may return to pandemic status in the future. And just because a disease is endemic doesn’t mean it’s less severe or not a public health concern. Influenza, HIV and tuberculosis are three endemic diseases that, combined, kill more than two million people globally each year.
The future of the COVID-19 pandemic
In the future, COVID-19 may become endemic, similar to the seasonal flu, but even if that happens, COVID-19 will still be a disease of major concern with negative health consequences for millions of people, including long-term effects (long COVID-19).
However, we’ve made great progress since 2020, and there are reasons to be optimistic that the worst outcomes from COVID-19 may be behind us.
The red line in the above graph depicts the seven-day daily average number of COVID-19 deaths in the United States since the start of the pandemic. This graph illustrates that even though there have been about 400 deaths per day in recent months, this is far below the peaks of the major waves of the first two and half years, when the U.S. had more than 2,000 COVID-19 deaths per day.
It is true, we do not know which variant or subvariant will be predominant this winter, or if a concerning new variant will emerge, as Omicron did last fall. But if we as a community take steps to minimize hospitalizations and deaths this winter, we have an opportunity to be in a far better place than the last two winters.
Reasons to be optimistic
- While more contagious, Omicron and its subvariants are generally less severe than the original COVID-19 strain in 2020.
- An updated booster dose that targets Omicron BA.4 and BA.5, as well as the original strain, is available now.
- COVID-19 vaccines and boosters significantly reduce hospitalizations and deaths (see graph below).
- Effective treatments are available to people at risk of severe COVID-19 illness that greatly reduce hospitalizations and deaths. These treatments were not widely available during the Omicron surge last winter.
- A significant portion of the population has been infected with COVID-19, which gives a degree of protection from COVID-19, although this wanes over time.
What you can do
- The best thing you can do to prevent severe COVID-19 illness is to keep up to date on COVID-19 vaccinations and boosters.
- Get a flu vaccine. Flu is expected to make a comeback this fall and winter, and the flu vaccine reduces the risk of severe illness or death.
- Stay home if you are sick.
- If you have been infected with COVID-19, you may consider waiting three months before receiving your next vaccination or booster which will rebuild your COVID-19 antibodies and offer superior protection to infection-acquired immunity alone.
- Pay attention to community transmission, consider wearing a mask in indoor public settings and avoid large indoor gatherings, especially when transmission is high or if you are vulnerable to severe COVID-19.
- Masks are no longer required in most settings, but they still reduce the transmission of COVID-19 and the flu.
- If you are at risk of severe COVID-19 illness, including being immunocompromised or over age 65, make a plan now on how you will access treatments if you become infected with COVID-19.