2022-09-27
Is Covid ‘Under Control’ in the US? Experts Say Yes
Promise: “I’m never going to raise the white flag and surrender. We’re going to beat this virus. We’re going to get it under control, I promise you.”
President Joe Biden caused a stir in a “60 Minutes” interview on Sept. 18 when he declared that the covid-19 pandemic is over.
“We still have a problem with covid — we’re still doing a lot of work on it,” Biden said. “But the pandemic is over.”
Critics countered that the U.S. is still averaging about 400 deaths daily from the virus, that nearly 30,000 Americans remain hospitalized, and that many others are suffering from “long covid” symptoms stemming from previous infections.
Two days later, Biden acknowledged that despite the negative reactions by some, the pandemic “basically is not where it was.” White House press secretary Karine Jean-Pierre called the coronavirus “a lot more manageable.” Past experience means “we know what works,” she said.
PolitiFact has been tracking a campaign promise Biden made in 2020 that is closely related, but distinct, from what Biden told “60 Minutes.” During the presidential campaign, Biden said, “I’m never going to raise the white flag and surrender. We’re going to beat this virus. We’re going to get it under control, I promise you. “
Biden is on safer linguistic ground with his promise to get covid “under control” than saying “the pandemic is over.”
There remains some debate among public health experts about whether the pandemic is “over” — or whether it realistically can ever be. There is no official arbiter for making that decision, and the word “over” suggests a finality that is not well suited for describing a pathogen that will exist in some form indefinitely.
However, we found broad agreement among infectious-disease specialists that the pandemic by now is “under control.”
When Biden was inaugurated, physical distancing was widely enforced, schools were often virtual, public events were rare or tightly controlled, and few Americans had yet received a vaccine. Today, life for many Americans is much closer to the pre-pandemic norm, with virtually all schools open, concerts and restaurants well attended, and travel back to its typical level.
“The nation clearly has made tremendous progress on covid-19 since President Biden’s election,” said Jen Kates, senior vice president and director of global health and HIV policy at KFF. “I would probably say that we are in a pandemic ‘transition’ phase — that is, moving from the pandemic into a post-pandemic period. But this is a continuum, not a cliff, where it’s a pandemic one day and over the next,” Kates added.
Dr. Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials, added that the promise to get the pandemic under control “is certainly well on course, or perhaps even met, as far as what the federal government can provide to accomplish that.”
And Dr. William Schaffner, a professor of preventive medicine and health policy at Vanderbilt University, agreed that the “emergent phase of the pandemic is coming to a close. We’re now moving into the ongoing struggle — call it a truce with the virus.”
Medical experts said pandemics inevitably become “endemic,” meaning that the pathogen is here to stay but does not present a widespread emergency.
“We will always have to manage covid in the medical system,” said Dr. Monica Gandhi, a professor of medicine at the University of California-San Francisco. “Unfortunately, although we can bring down deaths to very low, I don’t think we will ever get to zero deaths from covid-19.”
The level of U.S. deaths from covid is lower today than it has been during most of the pandemic, and it has been that way since the spring.
Notably, the number of “excess deaths” is also down. That’s a metric that gauges how many more deaths are occurring beyond the long-term average for that time of year. The number of excess deaths nationally per week has been consistently between zero and 5,000 since the spring, after peaking at 20,000 to 25,000 per week during four previous surges since the pandemic began.
Hospitalization has held steady recently at some of the lowest rates of the pandemic. And even this level may overstate the virus’s impact; routine testing upon admission often detects cases that are asymptomatic and largely coincidental to the reason a patient is admitted.
Gandhi pointed to data from Massachusetts hospitals showing that most hospitalized patients who test positive for covid have only “incidental infections,” with only 1 in 3 being treated primarily for a covid-related illness.
Experts noted that hospitalizations and deaths, even at these reduced levels, remain too high, and they cautioned that infections could increase as winter forces people indoors. Still, they credit the availability of vaccines and therapeutics, as well as the knowledge gained from living with the virus for more than two years, for the likelihood that the darkest days of the pandemic are behind us.
“I am not worried at all that we will go back to the scale of hospitalizations and deaths of the worst days of the pandemic,” said Brooke Nichols, an infectious-disease mathematical modeler and health economist at the Boston University School of Public Health. “We will likely enter into a seasonal covid vaccine situation, potentially combined alongside the flu into the same vaccine, and these seasonal vaccines will become critical to avoiding hospitalizations and deaths during the flu and covid seasons.”
There has been no major new variant since omicron emerged in late 2021, and even the most recent omicron subvariant to emerge, BA.5, has had a long run as the dominant strain in the U.S., prevailing since early July.
This doesn’t mean that a more dangerous new strain couldn’t emerge. However, public health experts take comfort from recent patterns. The trend during most of 2022 suggests that a rapid succession of ever-more-confounding — and vaccine-evading — variants is not inevitable. If a major new variant does emerge, mRNA vaccines like those made by Moderna and Pfizer-BioNTech can be updated fairly easily for it.
Vaccination uptake, though, remains an urgent question. About one-third of Americans are not fully vaccinated, and an even smaller percentage have received boosters. Plescia said “the main deciding factor right now is not going to be the president or the response of the federal government — it’s going to be the response of the public.”
“I think there’s disease fatigue and vaccine fatigue and wearing-a-mask fatigue,” said Dr. Georges Benjamin, executive director of the American Public Health Association. “People are just tired of covid and trying to wish it away, and it’s unfortunate because it’s not gone. We’re tired of it, but it’s not tired of us yet.”
Some experts caution that a pandemic “under control” doesn’t mean the costs will be minimal.
“The degree of protection afforded by the current vaccines available, especially to the most vulnerable, is of limited duration, and nonfatal outcomes from covid can still have knock-on consequences to the population health,” said Babak Javid, an associate professor in the division of experimental medicine at UCSF.
These consequences are called “long covid,” and nearly 1 in 5 Americans who have had covid are suffering from it. The Centers for Disease Control and Prevention defines long covid as symptoms lasting three or more months after contracting the virus that weren’t experienced before.
“Under control” suggests progress on keeping further spread within modest limits. It does not mean that people haven’t lost loved ones or felt continuing effects from the virus; clearly, they have.
What Does Biden Still Need to Do?
Biden and his administration still have work to do, experts said.
Several public health experts urged Congress to pass Biden’s request for $22 billion in covid-related funds. The White House has framed this funding as a way to be ready for a resurgence even though case levels are low now. It proposes that the funding support testing, research on new vaccines and therapeutics, preparations for future variants, and global assistance. Biden’s open declaration that the pandemic is “over” could make congressional approval less likely, however.
Gandhi said the federal government should do a better job targeting boosters and therapeutics at populations most at risk of severe breakthrough infections, notably older Americans and people who are immunocompromised.
And Schaffner urged more effective and unified messaging, with efforts to remove any hints of politics. “I wish the federal government would get together on who the main messenger is, and provide sustained, clear, simple messages,” he said.
Biden may not have used the most appropriate word when he described the pandemic as “over,” but the long-term statistical trends have been trending in the right direction, and the vaccines and treatments should dampen the severity of future waves. For these reasons, experts say it’s fair to declare that the pandemic is “under control.” If circumstances change, we will reassess our rating, but for now, this receives a Promise Kept.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.