Wednesday, September 21, 2022

The End of a Pandemic Is Not an All-Clear Signal -- But It Is Good News All the Same

by Neil H. Buchanan 
 
For the past several months, Covid-19 has continued to kill between 2500 and 3000 people every week.  This is good news only when compared to pre-vaccine times, when the Covid death rate was much higher.  It would thus be inaccurate to say, for example, that "Covid is over," or that everything can go back to normal again.

Some deniers were in fact saying irresponsible things along those lines from the very beginning, and they were and are wrong.  President Biden, however, did not say that.  He said during a recent interview that the pandemic is over, which can be true even while it is also true that we need to continue to worry about Covid-19 going forward.  Unsurprisingly, however, many people immediate jumped on Biden for his comments.

Biden was right, and even though some commentators are characterizing the White House's efforts to clarify the situation as "walking back" his comments, the better way to think about it is to say that it is important for the Biden team to make clear what he did and did not say.  And what Biden said was true.  Why resist good news?

Normally, I would be among the first to chide Biden for being too optimistic or for having a tin ear.  I would have pointed to the death rate and said that such a toll could not possibly be consistent with the end of a pandemic.  It is no surprise that people who are liberal (including the late-night comedians) and genuinely "of the left" (including MSNBC's Mehdi Hasan) were quick to ridicule Biden's comment, because we often find fault with what he says.  Criticism of Biden is not always merely a partisan matter.

The fact is, however, that the word pandemic does not mean "a disease that kills a lot of people."  Because I respect expertise and care about precision in language, I wanted to know whether what is happening now is in fact no longer consistent with the definition of a pandemic.  I did not know the answer, because this is not my area of specialized knowledge.  Fortunately, the editors of The Washington Post's opinion page (despite their many frustrating instincts) had the good sense a year or so ago to bring on Leana Wen as a regular writer about Covid-19.  Wen is a medical doctor and an expert on Covid-19 with deep experience in public health.
 
In The Post two days ago, Wen's column appeared under the headline: "Biden is right. The pandemic is over."  I suppose it could matter in some contexts that Biden might have been right for the wrong reason, and Stephen Colbert understandably mocked Biden for claiming in that interview that "[i]f you notice, no one’s wearing masks," with the camera then showing Colbert's studio audience all wearing masks.  But Wen's column convincingly argues that it is accurate to describe the pandemic phase as being over.

We are now in a better place, but it is not a great place.  Covid-19 was not defeated, and it is apparently not going to go away.  It will be killing people every day, just as other diseases kill people every day.  Nonetheless, Wen writes: "By multiple definitions, the pandemic is over. That doesn’t mean that the coronavirus is no longer causing harm; it simply signals the end of an emergency state as covid has evolved into an endemic disease."  Endemic diseases kill people, and pandemic diseases also kill people.

What is the difference?  "A pandemic is something that upends our daily lives and profoundly alters the way that we work, go to school, worship and socialize," Wen writes, adding:
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.
Interestingly, then, this scientific definition of a pandemic is in fact a social scientific definition.  And despite Colbert's effective visual joke, it turns out that Biden was right in part for the right reason: people are going mask-less more and more.  Wen also notes that there is some disagreement among experts about whether the pandemic is over as a scientific matter, but she concludes: "Perhaps the most significant rationale in favor of the transition from pandemic to endemic is the growing consensus that covid will never be eradicated."
 
That means that the pandemic can stop being a pandemic not only if it stops killing people but if it will never stop killing people.  Weird, right?  That merely means, however, that the emergence of a deadly new disease is not a one-way ratchet, where it continues to be called the worst thing it has ever been called.  Better does not mean perfect.  And if one thinks about it, that has to be true.  The 1918 influenza pandemic was a pandemic until it stopped being one, even though many, MANY people have died of the flu in the century since it ended, and many more will die of the flu in the future.
 
I am spending the Fall semester in Vienna, and even though infection rates here are much higher than in the US (although case reporting in Austria is probably more accurate than in the US, for various reasons), the only place that one can see masks being worn is on the city's (excellent) public transit system.  I expect to continue to wear a mask on any kind of public transportation for the rest of my life, even if Covid goes away completely.  That is in part because I travel extensively, and I used to come down with at least one nasty flu every year -- with symptoms that felt much worse than my experience with Covid two months ago.  It turns out that annual bouts of flu were not inevitable, and I can look forward to healthier traveling in the future.

Even though Wen's column was convincing and was offered with appropriate caveats, the editorial board of The Post could not contain themselves, choosing to run an ill-informed rebuttal to Wen's column on the very day that they published her expertise-based argument.  Predictably, the editors are confused.  In addition to offering statistics to show that Covid is still Covid (that is, that it kills people and mutates), they note that, "[w]eighed down by the virus, average life expectancy of Americans fell in 2020 and 2021, the sharpest two-year decline in nearly 100 years."
 
OK, so the pandemic was a pandemic in 2020 and 2021, as nearly everyone agrees.  That does not mean that it is still a pandemic.  The editors then add: "Covid-19 is the third-leading cause of death in the United States after heart disease and cancer."  Right, so are heart disease and cancer pandemics?  I never thought so, because people can die (even in large numbers) from non-pandemic diseases.  The editors also say that "waves of new variants have been anything but predictable. The arrival of omicron was just last Thanksgiving. What’s in store next? No certainty exists, except that the virus is still mutating."  Right again, but so what?  A future coronavirus variant might cause a new pandemic, just as a future influenza variant could cause a new pandemic.  So could highly transmissible variants of diseases like the plague or other deadly diseases that we can only imagine.

Many of Biden's detractors seem to be blaming him for the way Republicans are responding to his comments.  Specifically, Republicans are saying that if the pandemic is over, then Biden should not be asking for Covid-related funding.  Wen's response is exactly right:
[T]here are many other ailments that deserve far more attention, from the epidemics of opioid overdose and obesity to the reemergence of polio and the worsening mental health crisis. Removing the “pandemic” designation for covid places it among the list of diseases harming Americans, all of which require focus and funding.
The Post's editors end their piece with this: "'The pandemic is over' sounds nice, so desperately welcome. But we are not there, yet."  Well, it turns out that we are there.  At best, the editors are arguing that Biden should not say so out loud.  This effectively gives Republicans a heckler's veto, with Biden being told not to speak the truth lest people misinterpret what he said in bad ways.  That argument would be a lot more convincing if Republicans had not shown again and again that they will offer bad-faith arguments in response to anything that Biden says.

Why should Biden not bring people's attention to good news, even as he continues to show his seriousness by pushing for the post-pandemic (and anti-future pandemic) funding that we still need?  Presidents take a beating for bad news that is not their fault (hello, inflation panic!), and they take credit for good news that is not always their doing as well.  Here, however, Biden has actually presided over a sensible response to what was once a society-altering pandemic.
 
That part is over, for which we should be grateful.  We as a society have shown that we can fund research and take precautions against diseases that are not pandemics.  Covid-19 is still killing a lot of people, and we should continue to try to fight against that disease, similar to the ways that we fight against other public health problems (other than gun violence, which our political system forces us to tolerate rather than fight).
 
But refusing to acknowledge and celebrate good news when it is staring us in the face is like saying, "What does it matter?  In a hundred years we'll all be dead anyway."  It matters because we have gone from a terrible situation to a situation that is still bad, but we would all rather be where we are now than where we were a year ago.  To mangle an overused song lyric: "Still worry, be happy."