How does a pandemic end?


A: I’ll borrow a phrase from T.S. Eliot. This is how a pandemic ends. Not with a bang but a whimper.

There is no single indicator that a pandemic is over. In our modern times, we wait for a statement from the World Health Organization (WHO) to declare when a pandemic begins and when it ends. The greatest indicator that the pandemic is fizzling-out is when the rates of death and transmission diminish worldwide. Until our mitigation efforts are coordinated across the world, and vaccines are distributed evenly, we will be in the COVID-19 pandemic for a long while.

A few months ago, the World Health Assembly, the highest decision making body of the United Nations’ WHO, met to consider the urgency of ending the pandemic and how to brace for the next.

The reports available at this time are primarily agendas for the meeting and a brief statement of current affairs that we hear on the nightly news.

There are three principle strategies used over the centuries by nations and communities to address pandemics as far back as the Antonine Plague (165 AD) and as recent as the HIV (1980) and Ebola (2014) pandemics. They are:

1. Race through it. Do nothing. Some may argue that regions of the world are “trying” this method by denial and misinformation. The results are evident. Collapse of healthcare systems, death by virus and/or lack of access to emergency medical care/hospitalization, and failed infrastructure to assist those with the most urgent needs lead to great loss. Those people who survive develop natural immunity. The pandemic ends with a whimper over a few years. In some cases, it takes decades for regional surges to end. (plagues of antiquity)

2. Delay and vaccinate. Communities slow/delay the spread of disease by mitigation practices, attention to good hygiene, wide-spread testing, contact tracing, and quarantine. All depends on the specific disease, but 40-90% of people who develop antibodies through vaccination foster herd immunity. Outbreaks may occur seasonally until effective vaccines are available for all. (smallpox, influenza, Ebola).

3. Coordinate and crush. This is the most difficult strategy of all. It requires countries and communities to simultaneously starve the disease through quarantine, distance and restricted travel. There must be an agreement to lock-down until rates of transmission and death diminish significantly. The Black Death was curtailed by the introduction of quarantine. Prior to this pandemic, isolation was practiced. During this plague, merchant ships and their crews were required to remain in port and border for 40 days before coming ashore. This is the where the word “quarantine” originated. (Black Death, early cholera pandemics)

We have come a long way in the past 2 years with COVID-19. We have a long way to go. It is up to people to determine how long this pandemic will last. With the Delta variant on the rise and others to come, we have much work to do. The clearest conclusion that emerged from the World Health Assembly comes from Director-General Dr. Tedros Adhanom Ghebreyesus in an exit interview. He said, “The pandemic will end when the world chooses to end it.”

World Health Assembly:

World Health Organization

Global Health Council

VOA News

Pandemic History:

MPH Online

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