The US is in a ‘Controlled Pandemic’ Phase. But What Does That Mean?

They were the words everyone has been waiting to hear—that the COVID-19 pandemic is dialing down from the five-alarm fire that flared up in 2020 to a somewhat lesser conflagration. On April 27, the U.S.’s chief medical advisor, Dr. Anthony Fauci, described the country as in a “transitional phase, from a deceleration of the numbers into hopefully a more controlled phase and endemicity” in an interview with the Washington Post.

His comments come almost two years to the day after pharmaceutical manufacturers shipped the first batches of their COVID-19 vaccines for early testing. Fauci noted that those vaccines, as well as drug treatments that can control the virus in infected people, are largely responsible for the fact that the initial urgency of the pandemic as a public health threat is over. But COVID-19 itself isn’t quite finished with us. The virus continues to mutate, and the latest variations being reported out of South Africa—new subvariants of Omicron including BA.4 and BA.5—are sobering reminders that the virus isn’t standing still.

“Pandemic” vs. “Endemic”

Although we may be out of the urgent pandemic phase, we’re not quite ready to call COVID-19 endemic, which would mean the virus is still among us but relatively under control, similar to influenza.

And it’s not clear when that will happen. Even if it does, health experts may not all agree about the transition. There are no hard and fast definitions for “pandemic” and “endemic,” and no thresholds for case numbers or deaths that mark a shift from one to the other. The World Health Organization considers a pandemic to be an “epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people.” Experts have noted that these parameters say nothing about how quickly the outbreak is spreading, how much disease it’s causing, or what role immunity in the population plays.

But those are the factors that are critical for public health experts and political leaders as they manage a pandemic. There are no metrics for determining when to dial down an initial urgent response, or to pull back on drastic measures such as lockdowns and mask mandates.

That’s what the world is grappling with now—figuring out whether the risk of SARS-CoV-2 is now at a point where we can treat it more like influenza, by protecting ourselves as much as we can with immunization and basic hygiene such as washing our hands and covering our coughs, or whether we still need to manage SARS-CoV-2 as a serious enough threat for most people that we should maintain public health measures such as mask-wearing and social distancing

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