Numbers have a qualitative dimension. Or, the same number doesn’t always mean the same thing. If we had COVID-19 transmission numbers (we don’t, and beware grifters trying to tell you we do), they would not mean the same thing today as they did this time in 2020. The population of the US has changed, the virus itself has undergone several transformations, we have vaccines and therapeutics now that we didn’t have in 2020. This makes the medical (versus the social) end of a pandemic highly ambiguous.
We saw some outlines of this with the fruitless “epidemic or endemic?” arguments that have circulated in the COVID discourse, less and less frequently in recent years. I’ve done some public-facing work around this and given a couple of interviews, the upshot of which is that epidemic vs. endemic is a qualitative rather than a quantitative distinction. By this I mean that there is no threshold of infection or transmission below which an epidemic disease becomes and endemic one. Diseases are rendered as endemic via a complex socio-ecological process — adaptations are installed or not, pandemic income supports go away, the business of life, for those of us still here, must go on somehow.
Other examples I can think of. COVID cases are certainly much more numerous than cases of locally-acquired dengue in the US, but the dengue is more concerning to me as an epidemiologist. At this point, COVID is the devil everyone knows; one dark cloud on the horizon, for me, is the recrudescence of mosquito-borne illness in the USA. (Another one is pandemic influenza… although the COVID grifters are trying to latch on to it, it’s mercifully not an emergency; not yet, anyway.)
Or, to use a non-infectious-disease example, pregnancy-related mortality. The numbers tell a jarring story: Black and Indigenous people are unnervingly more likely to die in pregnancy or childbirth than their white counterparts. These numbers have a qualitative dimension that is expressed in quantitative terms as “relative” or “absolute” rates of mortality. Relative to white people, Black and Indigenous people have extremely high risk. In absolute terms, though, even the demographic groups with the most social privilege (white people) have alarming rates of pregnancy-related death. Which is to say, Black and Indigenous people bear the brunt, but the picture is not good even for white people. What to make of this?
When this qualitative dimension is not explored, public health interventions tend to focus on Black and Indigenous people and their experiences in the health care system. This focus is good; the associated problematization of Black and Indigenous populations is not. (I should say, this problematization is often benign in intent — but it looks like formulating research questions around the “problem” of, say, Black maternal mortality. This type of thing is all over public health research in every topic.) This can end up glossing over how much pregnancy-related mortality is iatrogenic (caused by medical intervention or contact with medicine itself) or sociogenic at the level of the whole population. In plain English, being white certainly protects you, but if rates of pregnancy-related death are still so high for white people, there must be something going wrong here in addition to structural and medical racism.
This brings me back, in an underground/unconscious way that I don’t fully understand, to COVID. At some point in 2020-2021, Death Panel (the podcast I used to be on but am no longer) started using the term “the sociological production of the end of the pandemic” to describe the very real and jarring disconnect between the quantitative reality of COVID-19 and the qualitative vibe cultivated in national media. At this point, I think the term and how it is used have long outlived their descriptive or proscriptive usefulness.
The way this term is deployed at this point in time strongly implies that the pandemic can never end and will never end. There are two undesirable corollaries to this implication. For one, it preserves the pandemic as a perpetually renewable (and exploitable) resource to gin up engagement. As a complex social phenomenon, COVID can and has been tied to every social and political issue under the sun; the effect, after nearly five years, is one of evaporation. Underneath the brutally unequal toll of COVID, the same stuff we always knew was a fucking problem. Obviously, this reservoir of engagement-bait is beneficial to those with some kind of vested interest in the the pandemic never ending. In general, though, I think it’s not for the best.
For another, the term and its use actually collapses the quantitative and qualitative (or “medical” and “social”) ends of the pandemic. This dumps phenomena as completely distinct as the privatization of the federal COVID response, individual and collective grief, and the simple passage of time into the same bucket of “bad things,” taking advantage of the irresolvable ambiguity in the quantitative/medical end of the pandemic to portray any forward motion as structural or administrative or interpersonal violence. Anyone who has been online knows the kind of confused and disturbing meanness this orientation cultivates. But more importantly, this is a maneuver to evade reckoning with what the end really does look like.
What if this is the end? What if COVID with us at a moderate ebb, continually? I do think it will continue to peter out over the next few years, and I also think it probably won’t disappear completely. What do we do about that? Tethering interventions to emergency situations means that the intervention goes away when the emergency recedes. The answer is to tether interventions to something else, not to cling to the emergency at all costs. Because the emergency will recede, and it doesn’t actually matter at all if it is receding quantitatively or qualitatively. (The qualitative sense is probably more important because, again, numbers are contextual.) What does it look like to think sustainably about COVID safety and public health more generally (because, at this point in time, the myriad other public health issues we face deserve just as much attention as COVID) in light of this?
It’s easier to just pivot to personal responsibility and stew in obstinate anger that shit sucks right now. No shade to anyone for doing that, although I think that ostensible science communicators should hold themselves to a higher standard. (One of the biggest failures of science communication from the left in the pandemic is the complete mishandling of messaging about the vaccines — they are not sterilizing, but that absolutely does not mean they don’t work, and it concerns and frightens me to see the attitude that the vaccines basically do nothing so widespread on the COVID-engaged left. I am implicated in this because I, mistakenly, advocated hard on the ineffectiveness of the vaccines to stop transmission out of an ultimately misguided belief that this would lead to the uptake of more nonpharmaceutical interventions, or at least build the case for it. I was wrong.)
The level of observation also matters. I read a snippet of Christian McMillen’s book Pandemics: A Very Short Introduction about the medieval bubonic (“black”) plague. Globally, the end of the plague looks like a disjointed petering-out. Locally, however, the end was abrupt, marked. We’re not as isolated as medieval serfs; there’s no way we’ll experience the end of COVID as abrupt. Other than that, I don’t know. Is this it? For me, maybe. For other people, probably not. One of the weirdest things about the pandemic is that everybody is living in their own peculiar temporality of it. Which I guess is all I can really say. The end of a pandemic is an emergent property of a complex system, not reducible to its parts or to any one person’s take or experience.
* I hate that I feel like I have to say this, but a disease being “endemic” or the epidemic phase coming to an end doesn’t mean I don’t care about it anymore (or that anyone should stop caring). I care very, very much about HIV, for example, a long-endemic disease that affects over a million people in the US.