(CNN) After more than three very long years, the time has finally come: the Covid 19 pandemic is at least formally coming to an end, both in Germany and abroad. This moment is not marked with parades or big parties, but with the flourish of two administrative pens. On Friday, the World Health Organization announced that Covid-19 is no longer an international public health emergency, and this Thursday the United States will end its own declaration of public health emergency.
What does that mean? During the pandemic, I’ve written several essays about the United States as if it were my own patient. I am thinking of the end of the public health emergency when my patient will finally be discharged from the hospital after a long illness. The hospitalization has been full of setbacks and improvements, wards to the intensive care unit and then back to the general nursing ward, vital signs verging on catastrophe, but also triumphs of modern medicine and human ingenuity.
And while it’s a very good sign that the patient is being discharged, it doesn’t mean that America (or the world) is completely screwed. There will continue to be testing, close monitoring and follow-up appointments – all hopefully to prevent a resumption.
Why now, WHO?
Last week, the WHO Emergency Committee on International Health Regulations met and decided that the Public Health Emergency of International Concern (PHEIC) should be ended due to declining Covid-19-related hospitalizations and deaths and high levels of immunity in the population.
The committee “recommended that it was time to move to long-term management of the COVID-19 pandemic,” and WHO Director-General Tedros Adhanom Ghebreyesus agreed.
But like me, the WHO plans to keep a close eye on the patient. The agency said that while Covid-19 is less of a concern, it still poses a global threat as the virus continues to evolve and spread.
“Even if we are not in crisis mode, we cannot let go of our vigilance,” said Dr. Maria Van Kerkhove, WHO Chief Technical Officer for Covid-19 and Head of the Emerging Diseases Programme. She added that the disease and the coronavirus that causes it are “here to stay”.
The PHE Declaration takes its last breath
Long before the WHO announcement, the United States had declared May 11th as the day the public health emergency would end. It may feel like any day, but it’s not as random as it seems.
When Covid-19 was declared a public health emergency in the United States on January 31, 2020, the nation was attempting to contain the spread of the SARS-CoV-2 virus.
The declaration – which has been renewed 13 times, typically in increments of 90 days – essentially gave the government wide-ranging flexibility in battling the biggest public health crisis in a century. It allowed the government to temporarily implement certain policies and measures.
At the societal level, for example, it has enabled a broader social safety net, the expansion of Medicaid in some states, and the ability to prescribe controlled substances via telemedicine. On an individual level, it gave Americans free access to Covid vaccines, tests and treatments. It also allowed the government to keep its finger on the pulse of the pandemic by requiring states and other agencies to report data such as test positivity rates, death rates and vaccination coverage.
On February 9, the US Department of Health and Human Services announced that it would extend the PHE one final time, and then said it would phase it out on May 11. This means an immediate end to some programs and promotions; others will subside more slowly, and some will remain in place.
Another change: The US Centers for Disease Control and Prevention is losing access to some of the data it used to measure the severity of the pandemic and guide its public health recommendations.
“It is the case at the end of the health emergency, we will have less [of a] window on the data,” said CDC Director Dr. Rochelle Walensky during a Senate committee hearing last week. “We will lose our percent positivity. We don’t get lab reports. We will not receive case reports. So we’re going to lose some of that.”
But Walensky, who is stepping down in late June, reiterated that the CDC is “not changing the steam with which we work to resolve this public health emergency.”
She said the agency will be closely monitoring this virus across the country, using novel approaches such as genome sequencing and wastewater testing.
We must remain vigilant. No one wants the patient to be hospitalized again.
Absolute numbers vs trends
If you only look at the absolute numbers, the decision to end PHE might leave you scratching your head. After all, there were nearly 9,900 new Covid-related hospitalizations in the US in the week ended May 1, and there were about 1,050 deaths per week at the end of April. When the first PHE declaration was signed in late January 2020, comparatively no deaths were reported in the United States (the first US death would not be counted until February 29). In fact, the number of deaths worldwide only surpassed 1,000 on February 10.
In medicine, however, numbers and data matter, but trends tell an even richer, more complete story.
Imagine my patient America coming into the hospital feeling sick for the first time. Maybe their fever was 38 degrees, their pulse was fast and they felt unwell. I took notes on their vital signs—cases, hospitalizations, and deaths—but what I really monitored was the trend. Have these numbers gotten better or worse? Had the illness reached its peak or was it just beginning? In early 2020, all of these numbers were trending in the wrong direction.
But for now the trends – in cases, hospitalizations and deaths – are all still high but thankfully moving in the right direction for my patient, our country.
This also applies globally. “For more than a year, the pandemic has been on a downward trend,” WHO’s Tedros said on Friday, explaining why the PHEIC statement came to an end. However, he said he would not hesitate to declare a global health emergency again if there were any significant increases in Covid-19 cases or deaths in the future.
To be clear, we have the ability to do a lot better and get the numbers down a lot further before we discharge our patient, but that raises a philosophical question, even more than a medical one: What are we ready for when tolerating society in order to prevent disease and death?
Over the last three years, I have spoken to public health and other experts many times to find out exactly when we would emerge from the pandemic phase and into the endemic stage of this public health emergency. There were few hard answers. Instead, many told me that what mattered was the number of Covid deaths that we as a society could endure in exchange for an end to the disruption to our lives.
At the time I wrote: “At what point do we as a society throw our hands up and say ‘we can’t do any better’ so we call this level of disease and death ‘endemic’ accept that pay and go with our lives keep going?”
We seem to have reached that point collectively and emotionally. If the US weekly death rate stayed constant (or represented the average weekly death rate) for 52 weeks at the end of April, we would have about 54,700 deaths per year. That puts Covid on a par with a bad influenza season. And remember, when it comes to the flu, less than half of the adult population in the United States receives a vaccine each year.
Solid medical science in the form of vaccines and effective public health strategies, like quality masks and indoor ventilation, can only get us so far if there isn’t a collective will to deploy them.
discharge papers
Many of us are ready for this chapter of history to come to an end, and to be honest I’m aware that many people moved on weeks – if not months – ago. But we must also remember that there is a sizeable group of Americans who are still very concerned about contracting Covid, particularly the older and sicker.
As you probably know by now, the CDC estimates that those aged 75 and older are between 9 and 15 times more likely to be hospitalized than those aged 18 to 29, and here in the United States nearly 25 million people are older than 75 When it comes to our overall health, a study published in the journal Clinical Infectious Diseases found that people with asthma had a 1.4 times greater risk of hospitalization than a healthy person, while those with high blood pressure had a 2.8 risk -fold increased, chronic kidney disease up to four times higher, and severe obesity up to 4.4 times higher. Someone with three or more conditions had a five times higher risk. Forty percent of Americans are obese, and nearly 70 percent of the country has at least one of the conditions that greatly increase their risk.
Therein lies one of the greatest lessons of the pandemic for my patient, the United States. Although we had tremendous resources to fight this pandemic, our collective ill health put us at a tremendous disadvantage. We must do everything in our power to focus on what matters, because no amount of wealth can buy good health.
Right now, however, my patient is taking crucial steps out of the hospital and back into the world. I’m excited.
On the discharge papers I write these farewell instructions: Be level-headed. Stay home if you are sick. Talk to your doctor about keeping oral antiviral medications (like Paxlovid) in your medicine cabinet if you’re at higher risk of hospitalization or death. Remember what Dr. Anthony Fauci recently said, “If you’re vaccinated and up-to-date and have therapy available, you’re not going to die [of Covid]no matter how old you are.” That should be reassuring for people like my parents who are now in their early 80s.
And yes, please use the formal end of the pandemic as a new beginning for yourself personally. Invest in yourself to achieve the best health possible, to feel better, happier, and stronger now, and to weather any medical storm in the future.
But above all, enjoy all the things that a major emergency or impending serious illness would not allow. Call if you have problems.
I wish my patient all the best. I wish you all the best.
CNN’s Andrea Kane contributed to this report.