There is no widely accepted scientific definition of when a pandemic starts or ends. Ending it is a political decision, and Joe Biden has made it.
There is no widely accepted scientific definition of when a pandemic starts or ends. Ending it is a political decision, and Joe Biden has made it.
S ince the beginning of the Covid-19 pandemic in early 2020, governments across the world have asserted emergency powers in response to the threat of this new biological nemesis. The United States, both the federal and state governments, was no exception. These powers dramatically expanded after Joe Biden became president, as, in response to a global disease, he wielded executive power on a scale never seen in this country.
This was largely accepted by the American public, though clearly there were elements that resisted. On the issues of school closures, mandated masking of students, border rules limiting entry of foreigners based on vaccination status, and employer vaccine requirements, we saw efforts to limit the powers being exerted by the president. But all of these powers originated with the assertion that an unprecedented medical emergency necessitated extreme measures to protect the public.
On Sunday, in a 60 Minutes interview, President Biden stated in the plainest terms the end of the pandemic emergency: “The pandemic is over. We still have a problem with Covid. We’re still doing a lotta work on it. But the pandemic is over.” Referring to the Detroit Auto Show, where the president spoke to CBS’s Scott Pelley, Biden observed, “If you notice, no one’s wearing masks. Everybody seems to be in pretty good shape. And so I think it’s changing. And I think this is a perfect example of it.”
The statement came as a surprise to the people to which this matters the most: Biden’s own public-health establishment. Dr. Ashish Jha, Biden’s top Covid adviser, told reporters as recently as September 6, “The pandemic isn’t over. And we will remain vigilant, and of course, we continue to look for and prepare for unforeseen twists and turns.” Covid-19 deaths are still averaging around 400 a day nationwide, levels that federal health officials have decried as “still too high.” Officials have also signaled that a public-health-emergency declaration for Covid-19 is expected to be renewed at least once more this year.
Unlike other historic Biden gaffes over the course of his political career of half a century, this was not a slipup. Biden has been saying similar things for months. In the Pelley interview, Biden was not caught off guard or tripped up by the question. It is quite apparent that this answer was long contemplated and considered.
That didn’t stop White House officials from attempting to walk back the comments on Monday morning, further undermining Biden’s credibility as leader of the country. According to CNN, an administration official told the outlet that “the president’s comments do not mark a change in policy toward the administration’s handling of the virus, and there are no plans to lift the Public Health Emergency.”
This is a ridiculous position. If the president (after much reflection and thought) isn’t to be allowed to declare an emergency or the end thereof . . . well, is he really the president?
The problem for the White House is not scientific or medical, but political. Whether or not the government-declared emergency that gave governments wide latitude in fighting the pandemic is over, the virus is still with us, and government will have to continue to marshal forces against it.
Furthermore, even though the pandemic emergency is over, it is questionable whether a pandemic ever “ends.” Instead, pandemics fade away. If we look at past history, large pandemics usually lead to the slow development of endemic disease that, sadly, continues to kill people, just at a lower, more publicly acceptable rate. There are numerous such examples. The most recent one that correlates most closely with Covid is the so-called Hong Kong flu. This virus, which caused the 1968 pandemic, was a novel influenza A (H3N2). The pandemic killed approximately 1 million worldwide, of which about 100,000 were in the United States. Most excess deaths were of people 65 years and older. The contours of this pandemic seem vaguely familiar.
So, when did that pandemic, which started more than five decades ago, end? The truth is that it is still not over. The H3N2 virus continues to circulate worldwide as a seasonal influenza A virus. Seasonal H3N2 viruses, which are associated with severe illness in older people, undergo regular antigenic drift, causing mild mutations that help the virus continue to wreak havoc around the globe.
As a scientific matter, it is quite easy to accept that the evidence and data here mean that a pandemic that initially killed a million people 55 years ago still is killing today. H3N2, and its variants, are one of the most common causes of seasonal influenza. It is difficult to quantify, but the World Health Organization estimates that 650,000 people die directly or indirectly from seasonal influenza every year.
Pandemic viruses may become less prevalent, may decrease in mortality, and may even go into hiding (as polio did after widespread vaccination). But in nature these pathogens never truly disappear, and they are a threat that exist with us, to one degree or another, forever. The recent surge in cases of polio (among the unvaccinated) should prove that.
So where are we, as a country and a nation, with the Covid-19 pandemic? Once vaccines were introduced in December 2020, we had a vehicle to dramatically reduce deaths of those most vulnerable to the virus. Deaths of the elderly plummeted.
However, deaths overall continued, and as the months passed, actually increased. The Delta variant, followed by the arrival of the Omicron variant, changed the target profile of those vulnerable to Covid-19. The average age of those hospitalized dropped during those periods. This was partially because the virus spread more widely during those times, but also because the younger age groups remained more resistant to the vaccine.
Today we are almost two years past the introduction of the initial vaccines. Deaths of patients with Covid-19 number approximately 400 a day. However, “with” is the operative word: Those 400 deaths are not all caused by the virus, and many at this point are examples of incidental or complicating circumstances. The reality is most Americans have some level of immunity from the virus from natural exposure, even without any vaccination. And a large percentage of those dying refused a medically proven, readily available prophylaxis.
A free society that is humane and caring can often provide solutions to problems; it cannot use state-sponsored force to demand people accept those solutions. The vaccine was widely available for free, and some people refused it nonetheless. Many of these deaths were preventable, but people chose not to protect themselves. A catastrophe that is largely caused by a failure of personal choice, instead of the unpredictable forces of nature, isn’t an emergency that the federal government should be responsible for.
Dr. Anthony Fauci, the retiring director of the National Institute of Allergy and Infectious Diseases, remains extremely worried: “We are not where we need to be if we’re going to be able to, quote, live with the virus, because we know we’re not going to eradicate it,” Fauci said. “We only did that with one virus, which is smallpox, and that was very different because smallpox doesn’t change from year to year, or decade to decade, or even from century to century.” Of course, if you carry Fauci’s concern to its logical conclusion, you would have to maintain a questionable government state of emergency in perpetuity — a situation that should trouble anyone who cares about individual rights in a constitutional republic.
Other experts are far more positive in their analysis. Dr. Leana Wen, a physician and liberal activist, says that Biden is right:
For most of the country, the pandemic is effectively over because it is no longer altering people’s day-to-day lives. To them, covid has evolved from a dire deadly disease to one that’s more akin to the flu. It’s still something people want to avoid, and they’ll take basic steps to do so, such as getting an annual vaccine. Some might choose to take extra precautions, such as masking in indoor settings. But the societal end of the pandemic has already arrived, a sentiment reflected in Biden’s comment. The scientific end of the pandemic might have arrived, too.
Dr. Wen is far from alone. Other prominent mainstream academic physicians agree with her, such as Monica Gandhi:
“We have all been questioning, ‘When does Covid look like influenza?’” says Dr. Monica Gandhi, an infectious disease specialist at the University of California, San Francisco. “And, I would say, ‘Yes, we are there.’”
Gandhi and other researchers argue that most people today have enough immunity — gained from vaccination, infection or both — to protect them against getting seriously ill from COVID. And this is especially so since the omicron variant doesn’t appear to make people as sick as earlier strains, Gandhi says.
If public-health policy-makers want to argue that the “emergency” is not over, that is reasonable. There is plenty of science that can support that position, and can be defended with evidence and data. It isn’t an argument I agree with, but it is an argument that has support from many in the medical and scientific community.
However, policy-makers should not be allowed to change definitions and move goalposts to determine the end of the pandemic. To do so is to give up on the entire concept of evidence-based medicine. Medical experts and the public at large most hold our leaders to account when they try to change the rules in the middle of the game.
The problem, of course, is that many in government have based numerous questionable actions on the declared Covid emergency. Whether it’s Trump’s Title 42 restrictions for illegal immigration, or Biden’s recent order canceling student-loan debt based in part on the effect of the pandemic on borrowers, emergency powers have been invoked to push forward policies that otherwise would not be enacted by Congress. Many politicians are twisting our health policy in order to push their pet political projects.
The fact is that there is no widely accepted definition of when a pandemic starts or ends. The WHO elects a committee to determine when a pandemic is declared, but even that body does not have a definition or process to declare a pandemic over.
What’s important is that, as a matter of legality and government, there is a person who can define when a federal emergency begins and ends, and only that person’s decision matters. In this case, that is President Biden, the democratically elected leader of the executive branch. As of now, Biden has declared the pandemic over, and that should be the standard we use in this country. It is the only proper way to move forward on the issue.