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The end of the pandemic will not come from biology or medicine — it will come from us

Almost two years later, as the omicron variant surged over the winter holidays, it dashed optimism among many that the end of the pandemic was near. This all-news of the new variants produced widely varying responses, with some suggesting it heralds the endgame of the pandemic and others doubling down on containment measures.

So when will the pandemic really end?

According to Fauci’s logic, the answer is only when the number of cases, hospitalizations and deaths come down and stay low. But as seductive as this notion is in its sheer clarity, it clashes with history: Over the past century, the end of respiratory pandemics has never been clear cut.

Instead, in four cases – the flu pandemics of 1918, 1957, 1968 and 2009 – hospitalizations and deaths attributed to the pandemic pathogen continued for years after the sense of urgency subsided. This reality reveals that the “end” of a pandemic cannot be determined by some kind of epidemiological milestone or by the acquisition of a miracle treatment that eliminates all risk associated with the virus. On the contrary, historically, the resumption of normal life – if it was even interrupted in the first place – guides the end of a pandemic.

Most experts agree that the 1918 influenza pandemic, caused by an H1N1 virus, had three waves, ending in the winter of 1919. Some, however, include a fourth wave and date it to the end of 1920 This cloudiness comes because the deaths have continued over the years. after the declared end of the pandemic; as recently as the winter of 1928-29, for example, H1N1-related deaths in the United States topped 100,000.

Yet while the 1918 pandemic may have lasted for years on paper – killing three times as many people as covid-19 after adjusting for population – in real life countermeasures have rarely been maintained for more than six weeks. Cities varied widely in how they dealt with the virus. For example, while many major cities closed schools for an average of four weeks in 1918, New York and Chicago — then the nation’s two largest cities — kept schools open throughout the pandemic. And as historian John Barry notes, many places experienced “several months of relative normality between the waves.”

While the story of the 1918 pandemic has become more familiar since the start of the last pandemic, those of 1957 and 1968 have received less attention.

During nine months in 1957-1958, about 66,000 additional influenza-associated deaths occurred in the United States and about “80 million Americans were bedridden with respiratory illness,” according to one report.

Even so, there have been no nationwide shutdowns or stay-at-home measures, and school closures have only lasted for weeks, if at all. People got sick but society kept spinning. This happened even though 60% of schoolchildren were sick, with schools showing average absenteeism rates between 20 and 30%, and teachers and health workers recording unusually high absenteeism rates. But even in New York, where 40% of students were absent at some schools, administrators said there was “no cause for alarm.” On the advice of the health department, they also did not reduce any activity.

Public health officials have made a conscious decision, in fact, not to cancel large gatherings and gatherings in an effort to stop or slow viral transmission. They considered that the epidemic was spreading too quickly for such measures to be effective. Instead, officials focused on providing medical care to those afflicted, not “preventing” the virus.

The 1957 pandemic came and went, but like the 1918 flu, the epidemiological impact of the virus continued long after normalcy had returned. As Newsweek reported in 1960, two years after the “end” of the 1957 pandemic, the same virus was “quietly wiping out nearly everyone it missed the first time.” One estimate put the number of additional deaths this season at 12,000.

By the late 1960s, a new pandemic virus had arrived: the H3N2 flu, which authorities say claimed 1 million lives worldwide over several seasons. Again, however, authorities put in place few countermeasures and disruptions to social life fluctuated between minimal and non-existent – ​​reflecting a society largely unaware of the deadly pandemic. While in December 1968, The New York Times called the epidemic “one of the worst in the nation’s history”, according to historian Mark Honigsbaum, “there were few school closings and businesses, for the most part, continued to operate normally”.

Why the 1968 pandemic was largely imperceptible to most people is unclear, but it may have to do with how mild it was. The season did not rank as particularly deadly compared to previous years, and much of society was preoccupied with the Vietnam War and other social issues. The pandemic was a major event for virologists and some epidemiologists, but for most of society it was not an event.

Yet as the epidemic wave of the 1968 pandemic receded, the H3N2 virus never disappeared. An analysis from the Centers for Disease Control and Prevention reported that strains of the virus were associated with, on average, tens of thousands of deaths per year for three decades after the pandemic.

Something similar happened with the “swine flu” in 2009. While the media devoted considerable airtime to the epidemic, the disruptions to life were fleeting and the epidemic largely spread. removed from public conversation within months. When the World Health Organization officially announced the shift to a “post-pandemic period” in August 2010, few people noticed, as social life had long since returned to normal. Yet, as in previous pandemics, the virus continued to circulate. According to CDC estimates, most post-pandemic seasons have seen the number of flu-related deaths exceed that of the pandemic itself.

Yet, although life has not been interrupted or returned to normal quickly during these four pandemics, we have dealt with covid-19 very differently. Although medicine has advanced over time, the hope of a vaccine or miracle therapy does not fully explain our different response. Indeed, a vaccine was produced in record time in 1968, with a total of 22 million doses distributed in the United States at the end of January 1969. But social life never stopped waiting for this vaccine.

Instead, our unprecedented focus on data may help explain why people have handled covid-19 so differently. Since the first phase of the pandemic, news sites and TV networks have consistently presented dashboards with data fueling perceptions of an ongoing state of emergency, prompting interventions and preventing our lives from resuming. social. The constant saturation of data has fueled the perception that only specific epidemiological measures will allow the resumption of normal life.

But despite our unprecedented ability to monitor the spread of SARS-CoV-2, history tells us that there will not come a time when the data signals the end of the pandemic. If history is any indication, covid cases, hospitalizations and deaths will be there for decades to come.

And for those adopting more stringent mitigation methods, it is crucial to understand that there will be no clearly definable biological endpoint to the pandemic. Only when they integrate the risk of covid into their lives and resume normal social interactions will the pandemic end. While they hope for a clean and neat endpoint, history indicates that such a thing does not exist.

In the end, it’s not the virus that makes the timeline – it’s us. The pandemic will be over when we say it’s over.

Tags : united states
Rodney N.

The author Rodney N.