COVID-19 Is No Longer a Public Health Emergency?

[Genady]

This article suggests that COVID-19 cases of hospitalizations and deaths are exaggerated now and most of the reported cases are with rather than from COVID-19. Consequently they recommend reconsidering public measures and related policies. I'd like to hear educated opinions of the members about this.

COVID-19 Is No Longer a Public Health Emergency | Time

[CharonY]

It is partially true, but perhaps not universally so. A few key points, the dying from and with COVID-19 can bit a bit muddled, depending on whether a give jurisdiction separates that data. Looking back at 2022, the omicron waves have hit countries quite differently and I think what we start to see is a change in the immunity status of the population. For example, for Canada 2022 was the deadliest year yet, as Omicron has swept the country and reached vulnerable populations that were not exposed during the less contagious waves (in conjunction with public health measures). 

Now that Omicron has infected the majority of the population basically everywhere, the hope was/is that they may be more resilient when it comes to severe disease. Some data seems to show that with some areas having relative constant, COVID-19 specific hospitalizations, despite having increasing infections when new variants arrived at some of the areas I have looked at. In

However, there are several issues with that. The biggest in my mind is that national data is at this point not terribly useful if you want to understand public health impact. In my mind, at the latest since Omicron the risk has shifted from individual risk, to population risk. Due to the massive and still not abating spread of Omicron lineages, our health care system is now systemically impacted. This includes obvious parameters such as hospitalization and death, but also increased risk of infection in vulnerable folks (e.g. cancer patients, immunosuppressed individuals, diabetic folks or otherwise vulnerable to inflammation). Whether you are hospitalized with or because of COVID-19, SARS-CoV-2 can cause complications. On top, we have lingering effects of sever inflammation and other issues, which ultimately put an almost constant pressure on virtually every health care system in the world. This has a ripple effect, resulting in excess health burden that simply would not exist without COVID-19.

Especially in low population density countries, outbreaks have vastly different impact on the health care system, too. I.e. if the next hospitals is hours (or days!) away a few missing beds due to COVID-19 hospitalizations can have vastly more impact than in area where folks can be shuffled between hospitals, for example. 

So in aggregate I would agree that the COVID-19 situations is, as a whole, in a different situation than at the beginning of the pandemic, with rapid mass deaths being less likely (at least so far). On the other hand it is still a bit of a semantic trick. Even if we do not think of it as an emergency, folks will die on a daily basis, we will have continued pressure on our health care system and our overall health is still going to be impacted. Perhaps one can think of it as the aftermath of a Tsunami, folks are less likely to be swept into the ocean now, but if thinks are not fixed, risk of cholera and other issues will increase.

There are also a couple of rather bad takes from the author of the article that I do not agree with. For example the assertion that the daily deaths in the US are comparable to a bad flu season does not take into account that those numbers would represent about 3-4 months of flu. In contrast in the post-emergency situation of COVID-19 that is rate that is mostly non-seasonal (i.e. continues throughout the year). I am also slightly perplexed why he picks out Denmark, when I believe the UK actually has actually segregated data. A quick check shows me that pre-COVID-19 England had somewhere between 1-2k deaths per year. In 2022 about 18k cases had COVID-19 as cause. Even if that was not stringent enough, and we cut it by half, at least for the whole year the situation does not seem that great. 

And I would also add that flu is not harmless. There is a reason why health authorities beg us to get vaccinated every year. And having two serious diseases circulating is going to put further strain on our health care systems. The tragedy is that once we move off the ledge, many think that the thing is over and it is time to have a picnic. In truth, the cliff is crumbling, and has for a long time, regardless whether we call it an emergency or not.

Edit: I clicked through some of the links in the article and my assessment on the article is not improving. Some might be just mislinked, as they do not seem to show the data the author was citing. But perhaps worse, he is citing an author who publicly made false statements on COVID-19 and vaccines.  I am not saying that the overall thrust of the article is inherently wrong, but the way it is built looks too much like cherry-picking to me. And if I were to write an opinion piece, I would stay the heck away from folks who have promoted falsehoods.

Edit 2: One of the things I feel that is missing is an honest discussion of what kind of disease burden we, as a community, feel acceptable. This includes direct damages due to the disease, but also disruptions in our health care and related factors. Howe much are we willing to spend vs what kind of damages (including deaths) do we feel is justifiable for a given price?

Edit 3: I should add the disclaimer that I am not an epidemiologist nor do I work on public health systems. As such this is really just my opinion based on my work and interactions with local health authorities as part of related projects.

[Genady]

Here is an article that, at least partially, balances the one in OP: We are all playing Covid roulette. Without clean air, the next infection could permanently disable you | George Monbiot | The Guardian

[CharonY]

Here is also a short article on the WHO comments on that matter:

Quote

In all, the committee determined that COVID-19 "remains a dangerous infectious disease with the capacity to cause substantial damage to health and health systems." In addition to the still-high death toll, the committee voiced concern for low vaccination rates in low- to middle-income countries, a dramatic decline in the monitoring of variants, continued spread of misinformation driving vaccine hesitancy, and the long-term threat of long COVID. The committee also acknowledged that "pandemic fatigue and reduced public perception of risk have led to drastically reduced use of public health and social measures, such as masks and social distancing."

https://arstechnica.com/science/2023/01/covid-is-still-a-global-health-emergency-but-end-may-be-near-who-says/