The COVID-19 global health emergency is not yet over, the World Health Organization says, but determining how to measure the end of a pandemic is not a simple equation, according to experts.
During a briefing on Thursday, WHO Director-General Tedros Adhanom Ghebreyesus made it clear he believes COVID-19 remains a global health emergency and that fighting it requires ongoing attention and diligence.
“I have said that the pandemic is not over, but the end is in sight. Both are true,” Tedros said. “Being able to see the end does not mean we’re at the end.”
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The number of weekly deaths is now just 10 per cent of what it was at the global peak in January 2021 and two-thirds of the world’s population is now vaccinated, including three-quarters of health workers and older people, which are all positive signs, Tedros said.
But 10,000 people are still dying of this disease every week, and that’s 10,000 too many when these fatalities are preventable, he added.
“We have spent two-and-a-half years in a long, dark tunnel and are just beginning to glimpse the light at the end … but we are not there yet.
“We are still in the tunnel, and we will only get to the end by focusing on the path ahead and by moving forward with purpose and care.”
Debate over whether the pandemic is still active was sparked late last week when when U.S. President Joe Biden declared in a Sunday interview “the pandemic is over.”
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Biden’s comments came after WHO said last week the end of the coronavirus pandemic is in sight, pointing to a global decrease in the number of weekly fatalities in recent weeks.
Maria Van Kerkhove, WHO’s technical lead on COVID-19, noted Thursday the UN agency did not actually declare COVID-19 a “pandemic” in February 2020, but rather declared the virus a “public health emergency of international concern,” based on the recommendations of WHO’s Emergency Committee.
That committee is now in active discussions about what criteria should be used to decide when COVID-19 is no longer an emergency, Van Kerkhove said.
“There are a number of factors that need to be taken into consideration, and these are still under discussion, looking at what is happening at a global level, what is happening in each country with the virus itself with the epidemiology,” she said.
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It turns out, there is no official outline on precisely how to determine the end of a global pandemic, says Isaac Bogoch, an infectious diseases specialist based out of the Toronto General Hospital.
“You’re not going to get a hard and fast definition, like you’re going to have different people define it in different ways.”
However, the WHO did publish a risk management guidance document in 2017 focused on how to manage influenza pandemics which it says are “unpredictable but recurring events.”
The document, which has been used by a number of countries including Canada, as a framework to guide its COVID-19 risk assessment and response, lists four phases of a global influenza health emergency: inter-pandemic, alert, pandemic and transition.
In his 2020 book, On Pandemics, epidemiologist and Order of Canada recipient David Waltner-Toews notes this WHO document “assumes that whenever we are not in a pandemic, we are between pandemics, as we are between ice ages.”
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“Although they were designed to manage influenza in humans, WHO phases can be applied to all infectious diseases,” he wrote in his book.
“There is no non-pandemic phase in our future. We have always lived between pandemics and we always will.”
For any one country to declare this particular pandemic to be “over” is problematic because multiple countries are facing different realities when it comes to its active cases, death rates and the availability of vaccines and antiviral medications, Waltner-Toews said in an interview.
“I think what (Biden) is trying to say is we’ve gone from this emergency situation — everything shut down, closed the borders, all of this kind of stuff — to a situation where we need to manage it,” he said.
In 2019, the federal government published — and has since updated — a “public health response plan for ongoing management of COVID-19” document, which included the WHO phases of pandemics and broad goals and objectives for each phase.
Ottawa has not officially said which of these phases it considers the country to be in at this time, but Health Minister Jean-Yves Duclos said Wednesday he does not believe the pandemic is over yet.
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“If someone isn’t sure whether the pandemic is done, I invite them to take a walk through a hospital and see … COVID isn’t over yet so we need to take care not only of yourself, but also health-care workers,” he told reporters in French.
Health Canada added in a statement the federal government Canada has “taken a comprehensive, layered approach with measures informed by available data, operational considerations, scientific evidence and monitoring of the epidemiological situation both in Canada and internationally.”
It is fair to acknowledge that Canada is in a more positive position now, but there continue to be unnecessary and preventable deaths even though Canadians have vaccines that can prevent these outcomes, Bogoch said.
But Canada, like other countries, has dismantled much of its testing and vaccine infrastructure, which could help bring the country further into recovery, he said.
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“During the first vaccine rollout that we had for doses one and two, we bent heaven and earth to put the vaccine into communities that were disproportionately impacted by the virus… bringing vaccine to the people, not bringing people the vaccine,” Bogoch said.
“It’s a lot to ask for, but if you really want to alleviate suffering from COVID-19, prevent death and also take a significant burden off of the health-care system, especially as we’re going into colder winter months in the northern hemisphere, you do that.”
Meanwhile, the virus is still circulating widely, is constantly mutating and remains unpredictable, which makes any declarations of victory difficult, Van Kerkhove said.
“This virus is here with us to stay and we have to manage it responsibly,” she said.
“We’re working on ending the emergency in every country as this is a global problem, we need to end this at a global level.”
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