President Joe Biden went on 60 Minutes last week and announced that the pandemic is, apparently, over. What a relief! Man, it really sucked when 500 Americans were dying every day from a preventable illness. Let’s see how many people are dying today…ah. Yes. Still 500 Americans a day. About the same as last summer, when it was still a “pandemic.” Just before it spiked again to 2,000 deaths a day. Interesting.
Okay, so here’s what Biden said in context: “The pandemic is over. We still have a problem with Covid. We’re still doing a lot of work on it. It’s — but the pandemic is over.” What does that mean, exactly? What does it mean to downgrade Covid from “pandemic” to “problem?”
If you watched my previous video about whether or not monkeypox is a sexually transmitted disease, you’re already well-prepared for where I’m going today. In science and medicine, there are terms experts use that are well-defined and easily understood, like the difference between a dog and a cat. But there are many, many terms that get messy and less well-defined the more you look into them, like the difference between blue and green. The word “pandemic” is such a term: there’s no exact point at which all experts will agree that a disease goes from being a problem to a pandemic. But there are some general traits that pandemics tend to share that outlets like the World Health Organization have tried to outline.
First is that a disease becomes an “epidemic,” when researchers see an unexpected increase in cases in a particular area. It doesn’t need to be necessarily contagious, or severe, and it doesn’t even need to be a bacteria or virus, as it can also refer to health-related behaviors like smoking.
The classical definition of a pandemic, then, is “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people.” Again, nothing to do with severity or contagion: just a lot of people all getting the disease at about the same time. That said, back in 2020 the World Health Organization said that in considering whether to call COVID an epidemic or a pandemic they were considering “the geographical spread of the virus, the severity of its effects and its impact on society.” A 2009 study found that the one thing all “pandemics” have in common throughout recent history is that they are widespread; because in reality, every disease outbreak is different in terms of what the disease is, how it spreads, the political climate at the time, and how calling it a “pandemic” might help or hurt efforts to mitigate it.
In the case of COVID, the WHO dragged its feet a bit, because at the time there was still some hope it could be contained but also possibly because they didn’t want to spark a worldwide panic. And that WAS a real concern at the time, with people already starting to do things like hoard food and medical supplies. That’s something I talked about back then, in early February of 2020: basically, how the WHO hadn’t called it a pandemic yet but they probably are going to, and please please please do not panic, just avoid crowds and wear a mask if you’re in a place where the disease is present. And even then I had people yelling at me that telling people not to panic was dismissive. It’s a difficult, if not impossible, tightrope for groups like the CDC and WHO to walk: accurately conveying the seriousness of the situation to billions of people, but making sure those people don’t go off and do something stupid based on your pronouncement. And let’s be honest, they didn’t always do a good job of staying on that tightrope.
While the downside of calling it a pandemic too early was people panicking, the downside of waiting is that the label “pandemic” is actually very useful for encouraging action on the part of individuals, NGOs, and governments. Provided that the label comes with detailed information about how dangerous the disease is, how quickly it’s spreading, and how to best stop the spread, the label of “pandemic” can give governments the public support they need to prioritize the disease, carve out a budget and institute policies to stop it.
And that’s what this is really about: not comparing your definition of “pandemic” to Joe Biden’s definition, or the WHO’s definition, or even the definition provided by the International Epidemiology Association’s Dictionary of Epidemiology, which has “epidemiology” in there twice so you know it’s legit. Providing a specific definition IS important for organizations like the WHO to provide guidance, but it’s not important for you and a bunch of strangers on Twitter, or dueling Washington Post op-eds, to argue over semantics. Because this is NOT about whether or not Biden is TECHNICALLY correct that the pandemic is “over” according to some definition. It IS about how the United States will continue to prioritize its response to a disease that is still killing 500 Americans a day. And the clear answer is that we will not.
Someone on Twitter asked in apparent good faith, “Globally, there are 660,000 cases of malaria and 1,700 deaths due to the infection each day. What’s the difference between that and a pandemic?” And it’s a good question! Scientists consider malaria to be endemic, meaning that it continues to cause damage but in a limited region. But in reality, you can easily catch malaria in any one of dozens of countries across four continents, which is pretty damned widespread and which would make it a “pandemic” by several “official” definitions. HIV/AIDS is another example: experts call it either an epidemic or a pandemic, but the latter has become much less common ever since wealthy countries figured out how to control the spread of the disease and treat patients who fall ill.
In a moving article in the Lancet last year, Dr. Chris Beyrer (Director of the Duke Global Health Institute) wrote about witnessing how the world responded to AIDS in the 1980s and ‘90s, about how watching the Reagan administration ignore what was happening and then crack homophobic jokes when they finally acknowledged it. He talks about the heroism of activists, doctors, and researchers who pushed and pushed for funding and research. And then he mentions a truly unlikely “hero”: George W. Bush. No, I’m serious:
“Most of the HIV patients on ART were in high-income countries. But most people living with HIV were in low-income and middle-income countries (LMICs). This painful period, from 1996 to 2003, was the height of the loss of lives from AIDS. Sub-Saharan Africa was by far the most affected region. AIDS care was then costly, complex, and challenging. Yet the idea that some would live, but most would die, based largely on geography, was morally and ethically unacceptable. It was at another International AIDS Society Conference, in Durban, South Africa, in 2000, that our movement was judged, fittingly, by a man living with HIV. Justice Edwin Cameron of the Constitutional Court of South Africa made a resounding case that the world had to act against this injustice to stop the needless dying. It was a profound call. And yet it seemed impossible that rich nations would invest the sums needed to make HIV treatment available worldwide. Few expected George W Bush’s 2003 State of the Union Address to mark a pivotal change. Yet it was. Bush announced the US President’s Emergency Plan for AIDS Relief (PEPFAR). By 2005, with the creation of The Global Fund to Fight AIDS, Tuberculosis and Malaria, and with PEPFAR, the needed billions began to flow.
“What followed was unprecedented. A global advocacy and political struggle to dramatically reduce the cost of ART. A commitment to treat, for life, millions of people. The annual cost of therapy in the USA or Europe was then some $22?000, and that eventually came down to $50 per year in LMICs, making treatment feasible on a vast scale. Death rates declined. Mother-to-child transmission slowed. New and better drugs, and eventually more potent preventive tools, were developed through a massive public sector investment in HIV research. Indeed, when the US National Institutes of Health sought trial sites for the COVID-19 vaccine trials in 2020, it turned to the HIV research networks and trial sites. Until COVID-19, the HIV research effort was the largest in history devoted to a single disease.”
Beyrer goes on to describe how unfortunately, the world’s attention has shifted once again, and COVID-19 has set back AIDS efforts even more. He writes that “The HIV/AIDS pandemic is far from over” but maybe we can take lessons from it to end the COVID-19 pandemic: HIV took “sustained investment in science” and “global human solidarity” to get treatment to the people who needed it most: marginalized people in Sub-Saharan Africa, sex workers, men who have sex with men. We can’t turn away just because “we,” the middle class, the white collar work-from-home crowd, the people with insurance, the young, the people with healthy immune systems, are now going to be okay. I’M going to be okay! I’ve gotten my vaccine, my booster, my second booster, and my bivalent booster. I have a great immune system. I’m in pretty good health. I live in an area with fairly low community transmission. I can go eat inside a restaurant and be reasonably sure that I won’t be exposed to COVID, if I am that I won’t contract it, and if I do contract it my immune system will handle it well. But my experience is very different from the experience of people in, say, Kenya, or Russia, or Texas, who don’t have nearly the same access to vaccines, healthcare, or populations with low community transmission. And for that reason I am quite comfortable to say that there is still a pandemic. I do NOT want my government to move on, to forget about the marginalized people who are still affected by this the way many of them did with HIV/AIDS. I don’t want them to throw their hands in the air and call it “endemic,” which is a fancy word for “we COULD end this but we choose not to.” We COULD spend a few more billion dollars to make sure everyone in the world has vaccines, education, and healthcare, but that would mean reducing some other budget item by a few billion dollars, like the Department of Defense would only get to spend, like, $752 billion next year. And then they couldn’t defend us any more. From…stuff.
So yeah, don’t get caught up in whether or not we call COVID-19 a “pandemic”. Focus on what it means when our government downplays it, and what that means for the people in the world who still need help.