End of COVID pandemic: Experts look for clues about past epidemics, including the flu

NEW YORK — Two years into the COVID-19 pandemic, most of the world has seen dramatic improvements in infections, hospitalizations and death rates in recent weeks, suggesting the crisis appears to be easing. But how will it end? Past epidemics can provide clues.

The endings of epidemics are not as thoroughly understood as their beginnings. But there are recurring themes that could offer lessons for the coming months, said Erica Charters of the University of Oxford, who is studying the issue.

“One thing we’ve learned is that it’s a long, tedious process” that involves different types of endings that may not all occur at the same time, she said. These include a “medical end” when the disease recedes, the “political end” when government preventive measures stop, and the “social end” when people move on.

The global COVID-19 pandemic has been waxing and waning differently in different parts of the world. But in the United States at least, there’s reason to believe the end is near.

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About 65% of Americans are fully vaccinated and about 29% are both vaccinated and boosted. Cases have been falling for nearly two months, with the U.S. daily average down about 40% in the last week alone. Hospital admissions have also fallen by almost 30%. Mask mandates are disappearing — even federal health officials have stopped wearing them — and President Joe Biden has said it’s time for people to return to pre-pandemic offices and many aspects of life.

But this pandemic has been full of surprises, lasting more than two years and causing nearly 1 million deaths in the US and more than 6 million around the world. Its severity was surprising, in part because many people learned the wrong lesson from a 2009-2010 flu pandemic that turned out to be nowhere near as deadly as initially feared.

“We were all worried, but then nothing happened (2009), and I think that was the expectation” when COVID-19 first emerged, said Kristin Heitman, a Maryland-based researcher who worked with Charters Has.

However, some experts offered lessons learned from past epidemics that could shed light on how the end of the COVID-19 pandemic might play out.


Before COVID-19, influenza was considered the deadliest pandemic agent. A 1918-1919 flu pandemic killed 50 million people around the world, including 675,000 in the US, historians estimate. Another flu pandemic in 1957-1958 killed an estimated 116,000 Americans, and another in 1968 killed another 100,000.

A new flu in 2009 caused another pandemic, but it turned out not to be particularly dangerous for the elderly – the group that tends to die the most from the flu and its complications. Ultimately, fewer than 13,000 U.S. deaths were attributed to this pandemic.

The World Health Organization declared in August 2010 that the flu had transitioned into a post-pandemic era, with cases and outbreaks moving into usual seasonal patterns.

In any case, over time, the pandemics subsided and the general population built up immunity. They became the seasonal flu of the following years. This type of pattern is also likely to happen with the coronavirus, experts say.

“It’s becoming normal,” said Matthew Ferrari, director of Penn State’s Center for Infectious Disease Dynamics. “There’s a regular, wavy pattern when there’s a season when there are more cases and a season when there are fewer cases. Something that will look a lot like a seasonal flu or cold.”



In 1981, US health officials reported an increase in cases of cancerous lesions and pneumonia among previously healthy gay men in California and New York. Cases kept popping up, and by the next year officials were naming the disease AIDS, for acquired immune deficiency syndrome.

Researchers later found that it was caused by HIV — the human immunodeficiency virus — which weakens a person’s immune system by destroying cells that fight disease and infection. For years, AIDS was considered a terrible death sentence, and in 1994 it became the leading cause of death for Americans ages 25 to 44.

But treatments that became available in the 1990s made it a manageable chronic condition for most Americans. Attention shifted to Africa and other parts of the world, where it has not been controlled and is still considered an ongoing emergency.

Pandemics don’t end with a disease abating uniformly around the world, Charters said. “A pandemic generally ends by becoming multiple (regional) epidemics,” she said.



In 2015, Brazil suffered an outbreak of mosquito-borne Zika virus infections, which caused only mild illness in most adults and children. But it turned into a scare when it was discovered that infection during pregnancy could cause a birth defect that affected brain development and resulted in babies being born with abnormally small heads.

Towards the end of the year, mosquitoes also spread to other Latin American countries. In 2016, the WHO declared an international health emergency and the impact on the US became clear. The Centers for Disease Control and Prevention received reports of 224 cases of mosquito-borne Zika transmission in the continental United States and more than 36,000 in US territories — the vast majority in Puerto Rico.

But the numbers dropped dramatically in 2017 and virtually disappeared shortly thereafter, at least in the US. Experts believe the epidemic died out as people developed immunity. “It just burned out” and the pressure to make a Zika vaccine available in the US eased, said Dr. Denise Jamieson, a former CDC officer who played a key role in the agency’s actions against Zika.

It’s possible that Zika will remain a dormant problem for years, but outbreaks could recur if the virus mutates or if larger numbers of young people come without immunity. With most epidemics, “there’s never a hard end,” said Jamieson, who now holds the chair in obstetrics-gynecology at Emory University School of Medicine.


The Geneva-based WHO declared COVID-19 a pandemic on March 11, 2020, and will decide when enough countries have seen a sufficient drop in cases — or at least in hospitalizations and deaths — to say the international health emergency is over is .

The WHO has not yet announced target thresholds. But officials this week responded to questions about the possible end of the pandemic by noting how much more needs to be accomplished before the world can turn the page.

COVID-19 cases are declining in the US and down 5% globally over the past week. However, cases are increasing in some places, including the United Kingdom, New Zealand and Hong Kong.

People in many countries need vaccines and medicines, said Dr. Carissa Etienne, Director of the Pan American Health Organization, which is part of WHO.

In Latin America and the Caribbean alone, more than 248 million people have not yet received their first dose of the COVID-19 vaccine, Etienne said during a news conference with reporters. Countries with low vaccination rates are likely to see increases in illness, hospitalizations and deaths in the future, she said.

“We’re not out of this pandemic yet,” said Dr. Ciro Ugarte, PAHO’s director of health emergencies. “We still need to approach this pandemic with great caution.”


The Associated Press Health & Science Department is supported by the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

Copyright © 2022 by The Associated Press. All rights reserved. End of COVID pandemic: Experts look for clues about past epidemics, including the flu

Dais Johnston

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