Experts Can’t Agree If We’re Still in a Pandemic

As a Health journalist, I've written the phrase “the COVID-19 pandemic” more times than I care to count in the four years since the World Health Organization (WHO) first used that term on March 11, 2020. But lately, the word “pandemic” has given me pause.

Maybe you’ve noticed it too: these days, a lot of people refer to the pandemic in the past tense. “During COVID,” they say, or, “when we were in the pandemic.” The implication is that the virus is gone and the pandemic is over.

The former is clearly untrue. The SARS-CoV-2 virus still kills thousands of people around the world each month, saddles still more with chronic symptoms known as Long COVID, and continues to evolve, with the highly transmissible JN.1 variant recently causing waves of infection across the globe.

But are we still a pandemic? No one seems to know for sure.

When I asked Dr. Mandy Cohen, director of the U.S. Centers for Disease Control and Prevention (CDC), she didn’t give a direct answer. “Rather than getting caught up in the semantics of it,” she says, people should feel confident that “we are outside of the emergency [phase]. But I don’t want folks to forget that COVID is still here and still poses a risk.”

Even Maria Van Kerkhove, director of epidemic and pandemic prevention and preparedness at the WHO, admitted that the issue is a “confusing” one. The WHO continues to describe COVID-19 as a pandemic on its website. Van Kerkhove says that’s reasonable given the virus’ continued global presence, even though we are no longer in the crisis state we were in 2020—but, she says, there’s no definitive, yes-or-no conclusion about whether that’s the right term to use.

“There is no universal, agreed definition of what a pandemic is,” Van Kerkhove says. “If you asked 100 epidemiologists to define what a pandemic is, or, ‘Are we currently in a pandemic?’, you’d get a lot of different answers.”

What’s a pandemic, anyway?

Epidemiologists consider a disease “endemic” when it spreads in a consistent way, as the flu does each winter in the Northern Hemisphere. An endemic level of disease is the baseline amount for a particular area, which might not be zero but is at least predictable. If a disease suddenly causes a higher-than-average number of cases in a set area, the situation becomes an “epidemic.”

The definition for a “pandemic”—when an epidemic crosses borders, infecting lots of people across multiple countries or continents—is perhaps the squishiest of all.

Calling something a pandemic is essentially a “judgment call,” because “there isn’t a precise number” of cases, hospitalizations, deaths, or affected countries that definitively denotes one, says Dr. Jonathan Quick, an adjunct professor at the Duke Global Health Institute and author of The End of Epidemics. “Anybody who gives you a precise number is just pulling it out of their head.”

Using that label is, in some ways, as much a political and public-relations decision as it is an epidemiological one. “If you’re trying to really reduce the number of deaths, you’ve got to be very strategic in what you do,” says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Language is part of the calculus, in that it can spur action from officials and the public alike.

But, technically speaking, labeling something a pandemic has no immediate policy implications. Even the WHO does not formally declare pandemics. The agency’s highest official level of alert is a public Health emergency of international concern (PHEIC), a designation meant to mobilize a global, coordinated response. (The PHEIC related to COVID-19 started in January 2020 and ended in May 2023, the same month the U.S. government stopped calling the virus a public-Health emergency.)

But, Van Kerkhove says, PHEIC is "not a good acronym. It doesn’t evoke the kind of action like the word 'pandemic' does.”

Representatives from WHO member countries around the world are working on a formal definition of a pandemic—four years after COVID-19 came onto the scene—as part of a wider effort to strengthen global pandemic preparedness. An alleged recent draft, which was published in February by Health Policy Watch, is a mouthful: “the global spread of a pathogen or variant that infects human populations with limited or no immunity through sustained and high transmissibility from person to person, overwhelming health systems with severe morbidity and high mortality and causing social and economic disruptions, all of which requires effective national and global collaboration and coordination for its control.” (A WHO spokesperson declined to confirm the legitimacy of that draft definition, but said a new draft of the group's work is set to be published this week.)

That reported definition doesn’t include numbers, but it does lay out more precise ground rules for what constitutes a pandemic. The pathogen in question must be contagious, novel—since humans don’t have significant preexisting immunity to it—and virulent enough to cause lots of death and disease, overwhelming Health systems and disrupting society in the process.

Is COVID-19 still a pandemic, or is it endemic?

Under those terms, SARS-CoV-2 still has some pandemic-y features. It’s still highly transmissible and circulating widely in countries around the world, and it remains a major cause of death and disability globally.

But it isn’t novel anymore, says Katherine Xue, a postdoctoral fellow at Stanford University who has studied viral evolution. The majority of the world’s population now has some immunity to the virus through vaccination, prior infection, or both, which means that “even a new viral variant is probably not going to be able to infect everybody” in the way the original strain could in 2020, she says.

COVID-19’s spread isn’t perfectly predictable—new variants are emerging all the time, causing spikes in infections all year round rather than seasonally—but it is consistently circulating around the world. To Xue, that means it’s fair to call it endemic. “The picture of COVID that we have now is probably going to be very similar to what we have four years from now, [whereas] the way we dealt with COVID was very different four years ago,” she says. “The rate of change is different.”

COVID-19 also does not overwhelm health systems in the way it once did. Today, with masks, tests, vaccines, and treatments available to some extent around the world, fewer people develop severe disease, and it’s easier to care for those who do. The virus continues to kill people and cause Long COVID, but global death rates are way down from their peaks.

Dr. Robert Wachter, chair of medicine at the University of California, San Francisco, has stopped using the word “pandemic,” which he says was a “shorthand way to convey to the public” that COVID-19 constituted a worldwide emergency that required a global shift in behavior. But calling it a pandemic now “just doesn’t feel right,” he says. In his opinion, we’ve been out of the pandemic phase for about a year, given the widespread availability of tests, treatments, and vaccines.

So what’s the word to use now? Experts interviewed for this story were hesitant to pick one. “We really don’t have the language for things that are somewhere between flus and cold viruses and pandemics," Quick says.

Does the label matter?

It may seem purely semantic, but ambiguity over the p-word has political and public-health implications. While many countries use other labels, like emergency declarations, to unlock funding and trigger coordinated governmental responses to a crisis, calling something a pandemic—even informally—has gravitas. And saying one has ended implies, rightfully or not, that the threat is gone, which may have trickle-down effects on research funding, disease-prevention efforts, and policies around sick leave and public services.

That may be why public-Health experts are so loath to take a firm stance. “I would be worried if the headline of your story is, ‘WHO Says We’re No Longer In a Pandemic,’” Van Kerkhove told me. “That would have a different level of meaning from a political point of view.”

Saying a pandemic is over also sends a message to the public that they can move on—assuming, of course, that they haven’t already. Only about 20% of U.S. adults got the latest vaccine, and a similarly small percentage said they were worried about COVID-19 going into this past holiday season, according to KFF data from late 2023. Lots of people stopped paying attention long before COVID-19’s four-year anniversary, and “the pandemic is over for them” regardless of how much experts debate the right vocabulary to use, Osterholm says.

Contrast that with the daily lives of people who remain especially vulnerable to the disease— including those who are elderly, immunocompromised, or coping with Long COVID—and it can feel like we’re living in separate timelines, Osterholm says. “Is the pandemic over for some people earlier than it is for others?” Osterholm says. “That doesn’t seem to make sense. That’s kind of like saying that there’s two different temperatures in Minneapolis in one night.”

Still, even Osterholm wouldn’t say which view is the right one, or when a pandemic is definitively over. “I couldn’t answer it for you,” he says.

Reconciling those different realities is unlikely at this point. And to Quick, that’s okay. “The key messaging is not about terminology, but about what behaviors are appropriate,” he says.

For people who still observe the pandemic, those behaviors won’t be at all surprising. Experts recommend getting vaccinated, staying home when you’re actively sick, getting tested and treated if necessary, and considering additional precautions like wearing a mask and improving ventilation. But with emergency declarations expired, mandates gone, and public guidance relaxing, whether you choose to do those things is now largely up to you. “We’re in a different place with COVID,” CDC director Cohen says.

Is that place a pandemic? It seems that’s also up to you.