After 2 years of a seemingly relentless pandemic that has upended work, education, and social interactions, the questions many are asking are when will we get back to normal and what will life be like after the cOVID-19 pandemic? In truth, science cannot fully predict what SARS-CoV-2 variants will arise and the trajectory of the pandemic. Yet, history and informed scientific observations provide a guide to how—and when—society will return to prepandemic patterns of behavior. There will not be a single moment when social life suddenly goes back to normal. Instead, gradually, over time, most people will view cOVID-19 as a background risk and abandon the trappings of pandemic caution.
The Great Influenza Pandemic of 1918 offers a historical guide to transitioning from a pandemic to an endemic infection. That pandemic began to subside after an estimated 500 million people—one-third of the world’s population—became infected, conferring high population immunity. (Approximately 50 million died worldwide, including 675 000 in the US.) The virus also mutated and became less pathogenic. Influenza H1N1 eventually reached an equilibrium, spreading among pockets of susceptible individuals without taking the lives of most.
SARS-CoV-2 may be following a similar trajectory. An estimated 94% of people in the US now have at least some vaccine- or disease-induced immunity against cOVID-19. The highly contagious Omicron variant may speed transition to an endemic phase, with more than 100 million US residents becoming infected. Omicron also appears less pathogenic than previous variants. Thus far, booster doses of messenger RNA cOVID-19 vaccines are conferring robust protection, with cOVID-19 hospitalizations 16 times higher for unvaccinated adults than for fully vaccinated persons in December 2021.
cOVID-19 will not be eliminated, and certainly not eradicated, in the foreseeable future. Intermittent surges will occur, driven by viral evolution and colder weather keeping individuals indoors. Ongoing vaccination will be needed because of waning immunity and viral mutations. cOVID-19 will also require surveillance similar to the Global Influenza Surveillance and Response System, a global platform for monitoring influenza epidemiology and disease that is used in formulating seasonal influenza vaccines.
A Cautionary Tale
There are major caveats to when the pandemic will wane, including the unknown duration of vaccine- or disease-induced immunity. Billions of people worldwide still are unvaccinated, facilitating rapid viral mutations. In 1920, a variant of influenza emerged that caused an outbreak so severe it could have been considered another pandemic wave. And a pandemic H1N1 strain emerged in 2009.
Although the Omicron variant appears to cause milder disease, future mutations may not be less severe. Viral evolution is not linear as many assume, with various strains likely to emerge. Vaccinating the world’s population will remain a major priority, along with effective cOVID-19 therapeutics.
Endemic is an epidemiologic term, whereby overall infection rates stabilize. The US Centers for Disease Control and Prevention (CDC) defines endemic as “the constant presence or usual prevalence of a disease or infectious agent in a population within a geographic area.” Endemicity is also determined by when countries decide to move from emergency response toward longer-term control programs. Several high-income countries are already developing postpandemic plans. During endemic phases, most people return to prepandemic patterns of behavior, depending on personal risk tolerance.
cOVID-19 management will likely resemble influenza-like illness surveillance. In the US influenza surveillance system—which itself requires modernization as well as improvement of data systems—the CDC partners with states, laboratories, and hospitals to detect influenza outbreaks, viral strains, and disease severity. cOVID-19 management will require rapid identification of case clusters and variants. Outbreaks may trigger testing, contact tracing, and isolation. Isolation duration might be reduced based on case and hospitalization rates as well as social and economic needs. South Africa, for example, recently announced it will not require isolation of asymptomatic SARS-CoV-2–positive cases.
Periodic cOVID-19 vaccinations, modified as new variants circulate, will remain a major control strategy. Vaccine mandates may resemble those for influenza, covering high-risk settings such as hospitals and nursing facilities. Proof of vaccination for dining, entertainment, shopping, and travel may eventually be retracted. It is unclear whether, or when, the CDC will add cOVID-19 to its recommended list of school vaccinations. Currently, only California and Louisiana require cOVID-19 vaccinations for school entry, although some localities mandate them for activities such as sports.
Mandates regarding the wearing of masks and social distancing may soon be relaxed, depending again on levels of risk. cOVID-19 mitigation strategies could be rapidly reimplemented to counter outbreaks, and then retracted when the threat subsides—requiring effective communication. Absent mandates, pandemic behaviors such as wearing masks may continue for vulnerable or risk-adverse individuals, especially in crowded places such as movie theaters and concert venues.
The public may no longer accept the most severe cOVID-19 strategies such as school closures, lockdowns, and travel bans. Denmark recently removed all cOVID-19 restrictions and Colorado’s governor declared “the emergency is over.” Highly restrictive measures pose significant social, educational, and economic costs.
A Return to Socialization
cOVID-19 risk mitigation resulted in profound social isolation and loneliness, evidenced by increased anxiety, depression, substance abuse, and suicidal thoughts. The public yearns for simple joys, such as embracing family members or friends, dining out, or seeing a smile unhidden by a protective mask. Humans are intrinsically social beings. It was not long after the 1918 pandemic when the US resumed intense socialization, with the Roaring 20s bringing people together in crowded dance halls, movie palaces, and speakeasies.
Some pandemic behaviors may continue, at least in part, if there is social utility. Hybrid working (remote and in-person) could outlast the pandemic, offering many employees a better balance between family and career and more choice in where to live. Air travel may also remain stagnant for the immediate future. By December 2021, international travel was 72% below 2019 levels, and it may not recover until 2024.
Eroding Public Health
It seems intuitive that a pandemic would increase reliance in, and trust of, public health agencies. That intuition appears mistaken. Trust in public health agencies declined significantly during the pandemic in the context of intense politicization over mitigation measures and confusing CDC guidance. States have enacted more than 100 new laws limiting health emergency powers, banning mask or vaccination mandates, and limiting governors’ emergency powers. The judiciary also curtailed public health powers, including the US Supreme Court’s decision to block the Occupational Safety and Health Administration’s vaccine-or-test mandate. The Supreme Court also overturned social distancing orders that placed limits on religious services.
The cOVID-19 pandemic has challenged society to reexamine the balance between personal freedom and public health in a postpandemic era. It may be too soon to shift to an endemic phase while Omicron-related hospitalizations remain high and effective therapeutics are scarce. The US has far higher death rates and lower vaccination rates than peer nations. But a gradual transition to normal will likely occur in the coming months, bringing back social activities that individuals have dearly missed. The ability of public health agencies to help society return safely to a new normal will remain critically important.
Lawrence O. Gostin is University Professor, Georgetown University’s highest academic rank conferred by the University President. He directs the O’Neill Institute for National and Global Health Law and is the Founding O’Neill Chair in Global Health Law. He served as Associate Dean for Research at Georgetown Law from 2004 to 2008. He is Professor of Medicine at Georgetown University and Professor of Public Health at the Johns Hopkins University. He is also the Director of the World Health Organization Collaborating Center on National and Global Health Law. This article originally appeared at the JAMA Health Forum.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
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Lawrence O. Gostin is University Professor, Georgetown University’s highest academic rank conferred by the University President. He directs the O’Neill Institute for National and Global Health Law and is the Founding O’Neill Chair in Global Health Law. He served as Associate Dean for Research at Georgetown Law from 2004 to 2008. He is Professor of Medicine at Georgetown University and Professor of Public Health at the Johns Hopkins University. He is also the Director of the World Health Organization Collaborating Center on National and Global Health Law. This article originally appeared at the 
