Is the COVID-19 pandemic over, or not?

It seems like a long time since the pandemic began. And now, as so much of life looks like it did before the pandemic, it's reasonable to wonder: is it over? It sure seems like it — even the president said so in September, and COVID precautions are barely seen in some locales.

Still, we continue to have thousands of new COVID-19 infections and hundreds of related deaths in this country each day. So, is it truly over? And what changes if that determination is ever formally made?

Defining a pandemic's start is tricky; the same goes for its end

When the pandemic began, I thought declaring an end would be straightforward: experts would count up conditions that marked a starting line, and once those conditions evaporated the pandemic officially would be over.

Unfortunately, it's not that easy.

As strange as it may seem, there is no single, agreed-upon definition of pandemic that all countries, public health agencies, and world leaders use.

The word itself comes from the Greek words pan (meaning all) and demos (meaning people), which makes sense: a key feature of a pandemic is that it can affect just about everyone. More common definitions include:

• an outbreak of a disease that occurs over a wide geographic area (multiple countries or continents) and typically affects a significant proportion of the population (Merriam-Webster Medical Dictionary)
• a sudden outbreak that becomes widespread and affects a whole region, a continent, or the world due to a susceptible population (MedicineNet.com)
• a disease prevalent throughout an entire country, continent, or the whole world (dictionary.com)

These standard definitions aren't particularly specific; what, exactly, does "multiple countries" or "a whole region" mean? How prevalent (widespread) does a disease have to be to be considered a pandemic?

And even if we could all agree on its definition, no single person, government agency, or public health organization has the authority to declare that a pandemic has begun or ended.

Moving from pandemic panic to endemic acceptance

Some people have suggested a pandemic is over when everyone is behaving as though it is: no more precautions, restrictions, or changes in behavior compared with the period of time before these started. But if that's true, people growing weary of restrictions, or those skeptical about their value, could ignore recommendations and create the impression that the pandemic is over — even as significant numbers of daily cases and deaths continue in the US and worldwide. That seems to be where we are with COVID right now.

Many pandemics eventually become endemic, meaning the infection is still present in a region or population but its behavior is predictable and the numbers of cases and deaths no longer spike. Learning to live with a virus is a key feature of an endemic virus; think flu or even the common cold. But it's probably true that the transition from pandemic to endemic can only be recognized after it happens.

What to do until the COVID pandemic is clearly behind us?

Perhaps setting a firm end date on this pandemic doesn't matter, anyway. What matters most is the number of ongoing infections, suffering and death, and the measures we should take to avoid infection. No one can say whether the coming winter months will bring a decline in infections, a continuation of the current situation (with hundreds of deaths and thousands of new infections each day in the US), or a spike in illness and death as more people are inside with relaxed precautions.

Common sense precautions still make sense, including these:

• Stay up to date with your vaccinations.
• Move indoor activities outdoors if possible and avoid indoor crowds, especially if you live in a place with high or rising numbers of COVID-19 cases.
• Wear a well-fitted mask in higher-risk settings (such as traveling in crowded conditions, crowded indoor settings, or on public transportation). Just because masking is no longer required doesn't make throwing out your masks a good idea.
• Isolate yourself if you test positive for COVID-19 (or if you have symptoms of COVID-19 and haven't been tested yet). Contact a doctor to decide whether you should take antiviral treatment if you test positive for COVID-19.

The bottom line

It's possible that experts will agree one day on a standard definition of "pandemic" and how to mark its arrival and departure. Already, policies regarding the pandemic (including financial assistance), and efforts to increase vaccination acceptance, are complicated by suggestions we're past the pandemic when we're actually not.

There's a lot that's still uncertain about the COVID-19 pandemic. Unfortunately, one thing seems clear: we can't call it fully over yet.