On Friday May 5th 2023, after 1,191 days, the World Health Organization (WHO) officially declared the end of the COVID-19 health emergency, stating it was no longer a “public health emergency of international concern (PHEIC)”. That brings to an end a more than 3 year global pandemic. We have followed COVID closely since the beginning, so it seems fitting that we mark this important milestone.
Of course, COVID itself is not over. There were 441,290 cases worldwide in the last 7 days. COVID is now more of an endemic infection, like the flu, which is exactly what most experts predicted would happen (once it became established). We are now living with COVID rather than trying to live through COVID. Let’s review some of the stats.
According to the WHO the total worldwide deaths from COVID are 6,921,614 – almost 7 million. Total cases are 765 million, more than 100 times greater, which puts the mortality rate a little under 1%. There have also been 13,349,209,463 vaccine doses administered. About 70% of the world population had at least one dose, but the figure drops to 30% in low-income countries. Total deaths in the US alone was 1.12 million. That’s over 3,000 deaths per million, which ranks us 15th in the world, and more than most other wealthy developed nations. New Zealand is at the bottom of the list with 0.2. Clearly there are many factors involved, and being an island nation helps, but this also reflects public health policy effectiveness.
The WHO recognizes that these numbers are conservative and likely not accurate. If we look at excess deaths during the pandemic, rather than only confirmed cases, the number rises to about 20 million worldwide, almost three times the official estimate. This is partly due to the secondary effects of the pandemic. For example, lung cancer deaths rose 5%, likely due to delayed screening and care caused by the pandemic.
It’s would have been hard to imagine in early 2020 that the pandemic would last more than 3 years and take such a toll. In medicine it is common practice to take a look back and see how we did, where things went wrong, and where there is room for improvement. So – how did we do?
Scientifically I think we collectively did extremely well, and the pandemic could have been much worse otherwise. The virus was quickly identified and a genetic sequence available in days. There was some initial fumbling in terms of the best public health policy, but we quickly settled on masking and social distancing as the best ways to reduce infection. This was a novel virus causing an unusual infection, and the learning curve was steep that first year. But the number of studies being published on COVID was massive, and within about a year doctors had a pretty good handle on best management strategies. Also within a year multiple vaccines had been developed, and the second year of the pandemic was marked by a massive effort to vaccinate the world with a corresponding massive impact on dampening down the pandemic.
Multiple studies have estimated the impact of the COVID vaccines. After the first year of vaccines it was estimated that they saved 20 million deaths worldwide. A December 2022 study found that in the US COVID vaccines saved 3 million lives and $1.15 trillion. Another study found that vaccines saved over a million lives across Europe. These are also likely underestimates because it is difficult to model the downstream impact of such a worsening of the economy, health care, and other aspects of society.
One area in which we did not do as well was education. We suddenly had to adapt to a deadly pandemic, and this came at an interesting time when the potential for remote online learning and working was possible but not mature or fully implemented. In my own field of medicine, this actually worked out great. We made years of advance in telehealth in just weeks and months. This is primarily because we were more than ready for telehealth and the only obstacles were bureaucratic – obstacles that were instantly cleared in the face of a pandemic.
In education the result was not as good. School systems did not have the infrastructure or training to adapt to online learning. We also did not have the data to know what the impact would be on younger children, who need the socialization as much as the learning. The negative impact of the pandemic on education was significant, widening education gaps that already existed. One study estimated that US students lost about one third of a school year due to the pandemic.
There is no simple answer to this situation. This does not mean that if we just kept schools open everything would have been just fine. Many schools struggled to stay open, even when they wanted to, because teachers and staff were out sick due to COVID, or were isolating because of exposure. We also don’t know what the net impact would have been on the pandemic itself if schools were open more, and what downstream effects that would have had. I don’t think it would have had a good long term impact on American education if the mortality rate among teachers skyrocketed.
I do think we can take away two big lessons from our experience with education during the pandemic. The first is that we underestimated the negative impact on young students of not being physically at school. The second (and this impacts the first) is that our education infrastructure was simply not ready for online learning. This is partly technological – having adequate setups at home and in the school for virtual learning, but also partly about the teaching itself. You can’t just do a live class program online. That’s like filming a play and calling it a movie. Lesson plans need to be optimized for the online experience, leveraging the advantages and mitigating the negative aspects. I have had both good and terrible online learning experiences. The question is – to what extent would a better prepared educational infrastructure have mitigated the negative impact of school shutdowns?
While we did well overall scientifically, and we did poorly overall in terms of education, I think the political response to the pandemic was mixed. This obviously varied from country to country, but also within a single country, like the US, politics had a massive impact on the pandemic. There seems to be a consensus that the pandemic revealed and exacerbated existing political dysfunction. This was partly driven by fear and uncertainty, especially early on. But the biggest negative impact was from the profound spread of misinformation and the imposition of political ideology and motivated narratives. We are still experiencing extreme misinformation about every aspect of the pandemic – people doubting the science on masking, social distancing, and the efficacy of the vaccines.
Politics mattered. There is overwhelming data now that vaccine rates in the US were lower and COVID death rates higher in Republican counties, in red states, and in people and locations that voted for Trump over Biden. Cumulative death rates in red states was 30% higher than blue states, and Republicans were 40% less likely to say that the pandemic is a serious health risk. Your attitude toward the pandemic and belief in mitigating actions and vaccines were largely determined by the information ecosystem in which you lived, and this translated into the probability of dying form COVID.
What does all this mean going forward? Specifically, are we ready for the next pandemic? While COVID is being portrayed as a once-a-century pandemic, this may be true only if we look backwards. This may no longer be true in the future, where there is increased globalization, and increased encroachment of humans into animal spaces. The experts warned us that a pandemic like COVID was coming. Our own Mark Crislip presciently laid out pretty much what a pandemic like COVID would be like, and that we would likely see such a pandemic roughly in the timeframe we did. Now those same experts are saying that another pandemic is likely sooner than later. Are we ready?
The short answer is – probably not. We need increased funding for pandemic preparedness. We need to have infrastructure ready to go. Hospitals need to have a plan, and extra capacity to handle pandemic surges. Public health organizations need to have the expertise and resources to manage communication in a world with social media and weaponized misinformation. This is not the 1950s anymore. As we saw, effective communication and countering misinformation may be the most effect tool to fight a pandemic.
We can also think about ways for schools to expand their ability to engage in remote, virtual, and online learning. Leveraging the potential of virtual learning can enhance even regular education, and those same skills and tools can become a backup for when in person learning is not safe or possible.
In short we need a pandemic game plan. And we don’t have one. This is a fixable problem. Perhaps we should take the occasion of the official end of the COVID pandemic to think seriously and plan extensively for the next one.