Less than two years after the World Health Organization declared the Covid-19 outbreak a Pandemic and less than 18 months after Covid-19 vaccinations were widely administered, there is no consensus on what stage of the epidemic we are now at. British restrictions were lifted a year ago and airline travel is on the rise. Do soaring case rates and continued individual health measures suggest the epidemic is still going strong?
The problem is that epidemics don't have nice endings. A quick and decisive endpoint, achieved through the quick application of scientific innovation, is usually not a realistic goal. We won't see anything like that with Covid-19.
Analysing past epidemics shows us that endings are drawn out and difficult to pin down. The political and economic consequences of emergency measures, as well as the medical realities of the disease, harms and treatments, need to be grappled with by societies. There is a lot of uncertainty surrounding the current state of Covid-19 because different groups have vastly different experiences of the medical, political and social aspects of the epidemic.
The end of an epidemic involves more than disease rates, according to research. The end includes the end of the crisis and regulations as well as the return to normal. These endings can be at odds with each other. It is more accurate to identify multiple endings to an epidemic if you take these different types of endpoints into account.
The history of recent epidemics shows this. When case rates don't result in a medical crisis, rates reach what is considered normal, expected, or locally acceptable levels. The WHO declared in August 2010 that the H1N1 epidemic was over. The end of H1N1 cases did not mean the end of cases, as the WHO stated. For a new disease, what is a normal, acceptable or manageable level? Differences of opinion over responses to Covid-19 disease rates demonstrate debates as to what is an acceptable level of infection, as well as who should decide this.
The end process is when authority negotiates and competes with one another, often debating fundamental social, economic and political priorities as much as medical data. War and political instability can change what local authorities and local communities deem normal, expected, or locally acceptable levels of disease, even in the face of persistent circulation of a disease. The war in Ukraine and soaring energy prices made Covid-19 reporting to the background.
The HIV/Aids epidemic has faded from the public's attention, but cases still exist. The disease has been transformed into a manageable condition thanks to medical treatment. Many in the global south don't have access to such treatment. The HIV/Aids epidemic in the global north has ended thanks to the success of medical interventions.
The medical end of the epidemic is shaped by political and social context. In places such as Africa, Covid-19 interacts with a variety of diseases. Understanding the end of epidemics as a drawn-out process explains long-term and global patterns of epidemics.
The story of John Snow removing the Broad Street pump handle to end London's 1854 cholera outbreak is a fable, not only because Snow never removed the handle, but because the disease was declining. The account of the end of the disease in London was gradual, requiring political negotiation over how to implement improved urban infrastructure and Sanitation along with slow social improvements. With HIV/Aids, regardless of modern epidemiological knowledge, the outbreak continues to this day.
Epidemics aren't just biological events that disappear with the disappearance of the disease. The moral crises are testing the limits of social trust. The crafting of narratives featuring heroes and villains is one of the things we are seeing in Covid-19. As medical experts debate what are acceptable infection rates, politicians debate the implications of lifting restrictions, and we debate with our relatives, friends and neighbours, we seem to be in the midst of such a process.
The professor of the global history of medicine at the University of Oxford is leading a project on how epidemics end.
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