If the Pandemic Is No Longer a Public Health Emergency, Then What Is It?
By David Quammen
"Mr. Quammen is a science writer and the author of “Breathless: The Scientific Race to Defeat a Deadly Virus.”
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The all-clear siren has sounded for now, though the war isn’t over. On May 5, the director-general of the World Health Organization, Dr. Tedros Adhanom Ghebreyesus, announced that Covid-19 is no longer a “public health emergency of international concern” — in the formalized shorthand, a PHEIC.
Lifting that declaration signals entry into a different phase of humanity’s collective battle against the coronavirus, SARS-CoV-2. Does this mean the pandemic has ended? No. Is the declaration premature? Expert opinions differ. What will this next phase of Covid-19 look like over the coming years and decades? We can only make carefully informed guesses, but two things are for sure: SARS-CoV-2 will still be among us, and the virus will continue evolving.
“What this news means,” Dr. Tedros said, “is that it is time for countries to transition from emergency mode to managing Covid-19 alongside other infectious diseases.”
No country should let down its guard, or dismantle protective systems created for the pandemic. No one should be misled to believe that Covid is now nothing to worry about. Deaths have been trending downward for more than a year but, as of last week, Dr. Tedros noted, the disease was still killing at least 480 people per day. Whether that constitutes an emergency will now be an individual question, not a global one, depending on whether the next fatality is you or someone you love or a stranger.
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The PHEIC designation (some sources tell us that the acronym is pronounced “fake,” an unfortunate phonic coincidence, given the reality) has been applied to just six other disease events since its creation in 2005: the swine flu pandemic in 2009; a resurgence of polio in 2014; the Ebola outbreak in West Africa that also began in 2014; the spread of the Zika virus in 2016; Ebola again, this time in 2019, in northeastern Democratic Republic of Congo; and the ongoing outbreak of mpox (formerly called monkeypox), which has been relatively low in case numbers and mortality though high in discomfiting strangeness, because it’s related to smallpox, among other reasons.
Still, older and less dramatic infectious diseases cause fatalities at higher rates than Covid presently does. Malaria, as of a recent 2021 estimate, kills roughly 1,700 people every day, most of them in Africa and under the age of 5. AIDS killed about 1,800 humans daily during the same year. The death toll from tuberculosis was larger, at about 4,000 per day. Is malaria an emergency? Yes, if you’re a parent in a village in Nigeria with no money for bed nets or drugs and your 4-year-old suffers a life-threatening fever. Is tuberculosis of international concern? You wouldn’t know it from the headlines.
I’m neither a public health expert nor a scientist, so I offer a citizen’s opinion: Yes, it’s time to cease calling Covid-19 a public health emergency of international concern. But the coronavirus is still with us, almost everywhere on the planet where humans live, and circulating also among whitetail deer, feral mink and probably some other wild mammals. It will remain capable of changing, adapting — and more quickly than the malaria protozoans.
Therefore, Covid is still certainly a public health situation of international concern. We’ll be living with it, and dying from it, some of us, forever. Meanwhile, we should probably rest and recharge the term “emergency” and save it for the next one — which could be H5N1 bird flu or something else, possibly beginning tomorrow.
Our efforts should shift to measures required for facing Covid-19 as a long-term cause of human illness, suffering and death, not a short-term catastrophe. We will need to keep improving laboratory techniques and manufacturing capacity for potentially ever-revised Covid vaccines. We will need to solve the outrageous inequities between high- and low-income countries in the availability of those vaccines. We will need to dissolve vaccine reluctance and refusal — among the privileged but obdurate, and also among those historically ill-served by Western medicine — with better communication and education. We will need to maintain, rather than reduce (as has been happening), our diagnostic testing for Covid and our sequencing of genomes from patient samples, in order to detect and trace new and immune-evasive variants.
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We will need to continue supporting laboratory research on the dangerous permutations of which SARS-CoV-2 and other RNA viruses are capable. And we will need to prepare, not just for the next coming of SARS-CoV-2 (when it emerges in a ferocious new form from some chronically infected human, or some deer or mink) but also for the next coronavirus or influenza virus or other highly adaptive animal-borne virus (there’s a whole rogue’s list of possibilities) that appears in humans, seemingly out of nowhere. But they don’t come out of nowhere. They come from nature.
The epidemiologist Dr. Michael Ryan, who serves as executive director of the W.H.O.’s Health Emergencies Program, spoke to this with eloquent passion, on behalf of his organization, at the same news conference to which Dr. Tedros announced lifting the PHEIC status. “We’re constantly in emergency mode,” Dr. Ryan said. “But we need the world to get into preparedness mode. We can’t just keep responding and responding and responding. We have to start preparing better.”
The first step is to realize: We live on a planet of viruses.
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