Pictured: Littering. Throw your masks away! Photo by Tim Mossholder on Unsplash

It’s 2022, nearly three years since the first cases of an unknown coronavirus were detected in Wuhan, China, and there’s a question on everyone’s mind: is the pandemic over? If not, when will it be done for good?

The question seems simple enough. It is anything but.

Stock photo results for “complex” are either roads or wires, apparently. Photo by Bofu Shaw on Unsplash

As with many things during Covid-19, the question of when the pandemic will be over, or if it already is, is almost impossible to give a single answer to, because like many things in epidemiology it’s all about definitions. If we define pandemic one way, maybe it’s already over and done, but using other interpretations it will probably continue on forever.

Sound like a headache to you? Imagine being an epidemiologist full time.

Defining Pandemics

There are many ways to define a pandemic, but they tend to fall into two main categories — scientific or social. The first type of definition is by far the simplest one, because it is fairly strict and easy to understand. The most common way of putting it is from a textbook called A Dictionary of Epidemiology which is currently on its fifth edition, and reads:

“an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people”

That’s uncontroversial in the infectious diseases epidemiology world, which makes the question of whether the Covid-19 pandemic is over scientifically seem quite simple: no. There are ongoing global epidemics of the disease, crossing international boundaries, affecting millions. A simple reading would say that the pandemic is not over, and because of ongoing infections probably never will be.

Searching stock photos for “simple”, on the other hand, seems to just give me random objects on a pastel or neutral background. Humans are weird. Photo by Mae Mu on Unsplash

Does that mean that large ongoing outbreaks of disease such as HIV or tuberculosis are pandemics? Well…yes. Despite these infections largely being eliminated in some wealthy nations, the scientific answer is that they still meet the criteria to be called pandemics and so technically are.

That being said, there’s some complexity in the discussion. We usually separate diseases that are endemic, or routinely present in populations, even if they sometimes cause epidemics, or large outbreaks over a specific time period, from pandemic disease. So, for example, technically seasonal influenza is a pandemic, because it meets the definition, but in practical terms we’d usually say something like seasonally epidemic instead.

If all of that sounds complicated, well, yes it is. Pandemics usually — but not always — refer to novel diseases, because these are the ones that grow the quickest and impact the largest number of people, but the definitions overlap to an extent. You could argue that Covid-19, as an ongoing disease that impacts large portions of the globe in something of a seasonal manner, is both a pandemic and an endemic disease.

Stock photos for “endemic”, on the other hand, are mostly plants and animals, referring to the biological definition of the word which is of course different to the epidemiological one (scientists can never agree on anything). Photo by Jeremy Bezanger on Unsplash

That being said, using the common scientific definition of the term, there is no question that Covid-19 still qualifies as a pandemic. It’s complex, but it’s also reasonably simple.

Social Pandemics

Thing is, most people aren’t referring to the strictly scientific terminology when they talk about whether pandemics are “over”. Presumably that’s because relatively few people have plowed their way through an epidemiology textbook recently, which is very understandable. When most people talk about the pandemic being finished, what they are referring to is the behaviour of people, rather than the behaviour of a virus.

Unfortunately, unlike the scientific terms, this broader and more vague description doesn’t really have a good answer. Do some people feel like life is back to normal, exactly as it was in 2019? Maybe. Is everything the same as it was before the pandemic? Not really.

Take one small example — healthcare. Ignore everything about how Covid-19 itself has or is impacting health services, or the death toll, or any of that. Let’s focus on one, relatively minor, thing — virtual care. Before the pandemic, having a medical appointment by phone or videoconference was doable, but only if you were lucky enough to have a doctor or local medical system that enabled the process.

Pictured: Uncommon before Covid-19. Photo by National Cancer Institute on Unsplash

And the numbers bear this out. In the UK, before the pandemic, somewhere around 10% of consultations with primary care doctors happened remotely. In 2021, this was closer to 50%, and by all accounts the proportion remains very high.

It’s likely that we’ll never quite go back to being the same as 2019 when it comes to virtual consultations, for any number of reasons. Many people see this change as a good thing, because it allows for more flexibility in healthcare for both patients and staff. It’s true that things have gotten a bit closer to where they were prior to the pandemic, but they’ll probably never be just like before.

And you see this sort of change everywhere. In Australia, where I live, prior to the pandemic no one ever wore a mask publicly. Even though the last restrictions requiring masks are now gone, you’ll still see quite a few people wearing them even in places where they were never mandated.

We still conduct many meetings online, because everyone’s realized that spending hours travelling just to be in the same room for an hour isn’t always the best idea. Sick days remain a more serious concern in many countries than they were pre-Covid, which most people would argue is a good thing because it stops us all from infecting each other once or twice a year.

Even stock photos for meetings are now pictures of Zoom. Look at all the faces! Photo by Chris Montgomery on Unsplash

Which brings us back to the original question — when will the pandemic be over in a social context? To me, the answer is pretty obvious — it depends entirely on what you mean by over. If you mean have we gone back to life entirely as before, then I’d say we’ll probably never get there and the pandemic is still ongoing. If you mean have most people moved into a framework of daily life that doesn’t include pandemic precautions like masks then I’d say…maybe? It probably depends on where you live, I doubt a person living in China would say that the pandemic is socially over in their country.

Bottom Line

The point is, whether you believe that the pandemic is over or not largely depends on what you’re trying to say. If you mean “have many/most people stopped living life like they did in 2020?” then in some countries the answer may well be yes. If you mean “have people stopped getting sick and dying from Covid-19?” then the answer is obviously no.

The question of whether the pandemic is over is largely in the eye of the beholder, which makes it complicated. Have we reached the point I wrote about in early 2021, where Covid-19 is an endemic disease that rarely kills? It mostly depends on who you ask. I would say no, but then I’m an epidemiologist looking at death statistics. At an individual level, with vaccines and newer treatments, Covid-19 in 2022 is probably not that far off influenza in terms of danger, so maybe some people are indeed justified in saying that the pandemic phase of the illness is over.

The point is that, as with most things in epidemiology, there is no simple answer to the question. Whether you think the pandemic is over depends entirely on how you define the words “pandemic” and “over”. For some, it’s definitely done — for others, it never will be. Neither of those perspectives is wrong, exactly, they’re just using different ways to define the same situation.