Will the coronavirus pandemic ever really end? - The Dallas Morning News

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As vaccinations have increased, North Texas is doing its best to return to normal: Masks are no longer required most places, workers are returning to offices and large gatherings are becoming common.

The statistics have given people with the protection of inoculation a strong sense of safety. Since early May, 60 or fewer COVID-19 deaths have been reported statewide on most days, and locally, 200 or fewer new cases have been reported on the majority of days in Dallas County. That’s a big change from January, when Dallas County was regularly reporting 2,000 new cases per day and the daily death toll statewide surpassed 400.

But health experts caution that the spread of more-contagious coronavirus variants and the still-significant portion of people who have not been vaccinated are a potentially lethal combination for people who haven’t achieved COVID-19 immunity.

The combination of circumstances has left many people wondering: When will the COVID-19 pandemic officially be over? Here’s what you need to know.

How does a pandemic end?

Health experts say there are three main ways that pandemics end.

The first is that a virus can be eradicated.

The only disease that has been wiped out in humans is smallpox. A combination of factors — a very effective vaccine, people could be vaccinated after they were exposed to the disease, and it was easy to tell when someone had the disease — made eradication possible, said Dr. Catherine Troisi, an infectious-disease epidemiologist at UTHealth School of Public Health.

People shouldn’t count on the elimination of COVID-19, though the fact that the virus “seems to be exclusive to humans” does make eradication a possibility, said Dr. John Carlo, CEO of Prism Health North Texas and a member of the Texas Medical Association’s COVID-19 task force.

“Through an aggressive vaccination campaign, we actually could eradicate it and completely shut it off,” he said.

The second way a pandemic can end is that a virus becomes what’s known as endemic. Endemic viruses, like influenza, are always present and circulating but don’t cause public health emergencies.

“Just like we see with flu, people still get sick, people die, but we don’t change our routines,” Troisi said.

The final way pandemics can end is though what’s known as a social ending. Essentially, people are no longer afraid, or no longer care, about the virus and return to their normal lives, Troisi said.

What about an ‘official’ end?

On Jan. 30, 2020, the World Health Organization declared that the COVID-19 outbreak was a “public health emergency of international concern.”

According to National Public Radio, a WHO committee meets every three months to determine whether an outbreak should retain that status, which is the highest health alarm under international law.

A little more than a month after the declaration, on March 11, the WHO characterized the outbreak as a pandemic. That characterization doesn’t have a formal meaning under international law, and can change if the spread of a disease slows, the WHO told NPR.

A characterization below a pandemic would be an epidemic, meaning there are more cases of a disease than what would normally be expected in a local area or community.

“In general, if the worldwide spread of a disease is brought under control to a localized area, we can say that it is no longer a pandemic but, instead, an epidemic,” the WHO said.

During the H1N1 influenza pandemic, the WHO declared the pandemic was over only four months after cases began to be detected. And after an Ebola outbreak that began in Africa in 2018, the WHO declared in June of last year that the disease was no longer a public health emergency of international concern.

But Carlo said people shouldn’t rely on word from federal or international health officials about the end of the pandemic, because cases and transmission can differ by locality.

“I don’t believe that we can expect a sudden sort of declaring a victory, or an end of the pandemic or something that would be kind of what we would see as almost like a victory parade,” he said, adding that because other countries are still experiencing significant outbreaks, COVID-19′s characterization and status probably won’t change soon.

COVID-19 probably will never go away

Health experts say the most likely scenario is that COVID-19 will always be around.

“Even if today magically everybody living right now became immune … there are children being born every day who will be susceptible,” Troisi said. “There will always be a new pool of susceptible people.”

As vaccinations increase and more people get sick from the virus and then recover, herd immunity will go up. But even if the majority of people are protected, that doesn’t mean a virus goes away.

Troisi gave the example of the measles virus.

“The estimates are you need to have 95% of a population vaccinated or immune,” she said. “However, if 95% of the United States is immune, or 95% of Texas, there are still groups of people where that’s not the case, and that’s where we see these outbreaks. You can still have these pockets of susceptibility.”

With COVID-19 vaccines, pockets of susceptibility could include neighborhoods where vaccinations haven’t been as common, children under 12 who aren’t yet eligible to be inoculated, and people who are immunosuppressed and don’t respond as well to the shots.

Health experts say the more people get vaccinated, the closer communities come to managing COVID-19 in a way that doesn’t harm daily life.

“People need to get comfortable with the idea that this fire — which we’re getting under control — is not going to go away,” said Dr. Marcial Oquendo, a pediatrician and member of the Dallas County Medical Society. “As we go forward, new variants are going to continue to emerge, new vaccines are going to continue to get better, people are still going to get infected and we’re still going to have ... [people] in the hospital five years from now. But we’re going to be better and better and better at dealing with it, and it’s not going to be as scary.”

If COVID-19 stays around, what’s next?

Health experts say there isn’t a set number of cases or deaths that would indicate the pandemic is over, or in a more manageable balance.

There’s also no official metric for the opposite scenario, in which COVID-19 cases would again be a cause of significant concern.

“Unfortunately, the best way we’re going to have of telling whether immunity is waning in those of us who are vaccinated, or it has arisen that the vaccine is not so good at protecting against [COVID-19], is a rise in cases,” Troisi said. “And by that time, it’s too late.”

She said that as schools and more offices reopen, epidemiologists and health experts will be in a “wait-and-see” mode to find out how COVID-19 transmission will be affected.

Carlo said one measure that could help would be setting up wider surveillance methods to detect variants, so the ones that are more contagious or resistant to vaccines could be detected while cases are still relatively low.

Dallas County now has a limited view of the total number of variants in a community.

Carlo said another next step in the process of getting used to COVID-19 would be setting a “baseline” for the number of daily cases that would be acceptable or normal in a community.

But the transmission of variants, as well as the unknowns about how long vaccines provide protection and whether people will need booster shots, make that baseline hard to determine.

“We still don’t know longitudinally how this all plays out,” he said. “How long do vaccines offer protection? Even beyond a few years, what does this look like? I think there’s still just a lot of unknowns.”

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