Just when we thought we had put the pandemic behind and begun to get on with our lives, Omicron has put the question back on everybody’s mind as to when will all this finally end? This research paper in the BMJ attempts to throw some light by studying past pandemics and juxtaposing the current context to conclude there isn’t likely to be a specific point in time which will be marked as the end. If at all, the end is unlikely to be based on epidemiological or biological parameters but more sociological and even then different parts of the world or different sections of society are likely to see different end points.
The paper begins with the study of past pandemics which show that that it is hard to identify the end of these pandemics even on a retrospective basis let alone real time.
“Respiratory pandemics of the past 130 years have been followed by annual seasonal waves fuelled by viral endemicity that typically continues until the next pandemic. What goes down comes back up, and the difficulty in dating the end of a pandemic is reflected in the historical and epidemiological literature. Although many scholars describe the “Spanish flu” as occurring across three waves from “1918 to 1919,” references to the “1918 to 1920” pandemic are also abundant, usually capturing what some call a “fourth wave.” Similarly, the mid-century “Asian flu” pandemic is generally described as a two wave event from 1957 to 1958, but others include a third wave, placing the pandemic’s end in 1959.
This variability in dating historical pandemics highlights the imprecise nature of using death rates to determine, even retrospectively, the “end” of a pandemic and the start of the inter-pandemic period. For example, CDC today states that around 100 000 Americans died in each of the 1957 and 1968 influenza pandemics. But these estimates include deaths taking place at times most would consider to be between pandemics (1957-1960 and 1968-1972, respectively).
The notion, reinforced by dashboards, that a pandemic ends when cases or deaths drop to zero is at odds with the historical evidence that substantial influenza morbidity and mortality continues to occur, season after season, between pandemics. In the inter-pandemic season of 1928-29, for example, over 100 000 excess deaths related to influenza A/H1N1 (the 1918 pandemic virus) are estimated to have occurred in the United States in a population one third the size of today’s. Furthermore, it can be challenging to discern which deaths can be attributed to the pandemic and which belong in the inter-pandemic period. The distinctions are not trivial, as excess mortality is the classic metric for assessing severity. Inter-pandemic years have sometimes had higher death tolls than the pandemic seasons that followed, such as the 1946-47 season that preceded the 1957-58 pandemic season (fig 1). Hence, a pandemic’s end cannot be defined by the absence of excess deaths associated with the pandemic pathogen.”
One could argue that unlike the past, this pandemic has been well tracked in terms of numeric dashboards which gives us a sense of caseloads, death rates, vaccine doses, etc which should help call the end better than in the past but the authors argue against:
“Some historians have observed that pandemics do not conclude when disease transmission ends “but rather when, in the attention of the general public and in the judgment of certain media and political elites who shape that attention, the disease ceases to be newsworthy.” Pandemic dashboards provide endless fuel, ensuring the constant newsworthiness of the covid-19 pandemic, even when the threat is low. In doing so, they might prolong the pandemic by curtailing a sense of closure or a return to pre-pandemic life.
Deactivating or disconnecting ourselves from the dashboards may be the single most powerful action towards ending the pandemic. This is not burying one’s head in the sand. Rather, it is recognising that no single or joint set of dashboard metrics can tell us when the pandemic is over.
….History suggests that the end of the pandemic will not simply follow the attainment of herd immunity or an official declaration, but rather it will occur gradually and unevenly as societies cease to be all consumed by the pandemic’s shocking metrics. Pandemic ending is more of a question of lived experience, and thus is more of a sociological phenomenon than a biological one. And thus dashboards—which do not measure mental health, educational impact, and the denial of close social bonds—are not the tool that will tell us when the pandemic will end. Indeed, considering how societies have come to use dashboards, they may be a tool that helps prevent a return to normal. Pandemics—at least respiratory viral pandemics—simply do not end in a manner amenable to being displayed on dashboards. Far from a dramatic “end,” pandemics gradually fade as society adjusts to living with the new disease agent and social life returns to normal.
As an extraordinary period in which social life was upturned, the covid-19 pandemic will be over when we turn off our screens and decide that other issues are once again worthy of our attention. Unlike its beginning, the end of the pandemic will not be televised.”
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