After over 1,191 days, the World Health Organization (WHO) has declared an end to COVID-19’s public health-emergency phase. The WHO announced on May 5 that COVID-19 is no longer a public health emergency of international concern (PHEIC) and that the focus would now be on the long-term management of the infection. The action reverses a declaration that was first made on January 30, 2020, when the disease had not even been named COVID-19 and when there were no major outbreaks beyond China. It is a major step towards the end of the pandemic that has killed close to 7 million people, disrupted the global economy and ravaged communities.
In the three years, three months and five days that have passed since the COVID-19 PHEIC was established, countries have reported almost seven million deaths to the WHO. But experts, including the WHO, believe that the pandemic’s true death toll could be two to three times higher, according to estimates from the WHO and others.
The WHO director-general, Tedros Adhanom Ghebreyesus, made the decision of ending the emergency phase of the pandemic following a recommendation by the organization’s COVID-19 emergency committee. During a meeting on May 4, the committee highlighted the decreasing numbers of deaths and hospitalizations and the high levels of population immunity against SARS-CoV-2 as reasons for ending the PHEIC.
Globally, as of 3 May 2023, there have been 765,222,932 confirmed cases of COVID-19, including 6,921,614 deaths, reported to WHO. As of 4 May 2023, a total of 13,349,209,463 vaccine doses have been administered globally.
The novel viral infection came to light after China reported a cluster of pneumonia cases with no known cause from Wuhan on December 31, 2019. By the end of January 2020, nearly 10,000 cases had been reported, including more than 100 cases in 19 other countries. WHO raised its highest level of alert and termed the infection a Public Health Emergency of International Concern, a designation that remained in place for over three years. A PHEIC — defined by the WHO as an extraordinary event that constitutes a public-health risk to other countries through the international spread of disease — is the highest level of international public-health alarm. In practice, this decision compelled countries to start reporting cases to the WHO to create worldwide surveillance.
Over the course of the time since COVID-19 was declared a global emergency, the following are the countries that reported the maximum number of cases and deaths.
Total COVID-19 Cases till May 1, 2023:
| Country | Cases |
| United States of America | 10,32,66,404 |
| China | 9,92,48,443 |
| India | 4,49,52,996 |
| France | 38,930,489 |
| Germany | 38,403,667 |
| Brazil | 37,449,418 |
| Japan | 33,720,739 |
| Republic of Korea | 31,176,660 |
| Italy | 25,788,387 |
| UK | 24,581,706 |
Total COVID-19 Deaths till May 1, 2023:
| Country | Deaths |
| United States of America | 1,124,063 |
| Brazil | 701,494 |
| India | 531,564 |
| Russian Federation | 398,366 |
| Mexico | 333,908 |
| UK | 224,106 |
| Peru | 220,122 |
| Italy | 189,738 |
| Germany | 173,044 |
| France | 162,868 |
The Significance of WHO’s Declaration
The WHO’s declaration of an end to the COVID-19 emergency holds profound significance in the global fight against the pandemic. It represents a transition from crisis management to long-term strategies aimed at controlling the virus. This declaration acknowledges the progress made in reducing the immediate threat of the virus through widespread vaccination campaigns, improved healthcare infrastructure, and effective public health measures. However, it is important to note that the declaration does not imply the complete eradication of COVID-19 but rather the recognition that the virus can be managed within the capacity of healthcare systems.
Over the last three years, doctors and researchers have figured out a lot — methods of transmission; who are at highest risk of severe disease and death; better, cheaper, and point-of-care diagnostics; a treatment protocol that works; medicines to prevent viral replication that can help in reducing severity of the disease; and most importantly, vaccines that can prevent severe disease. Governments have strengthened healthcare systems and rolled out vaccination drives. In India, more than 90 percent of people above the age of 12 years have received their two primary doses. Since many were infected and vaccinated, the population has developed a ‘hybrid immunity’ that has been shown to offer better protection against future severe disease. Vaccines were one of the major turning points in the pandemic. According to the WHO, 13 billion doses have been given, allowing many people to be protected from serious illness and death.
How did the pandemic pan out in India?
India witnessed three distinct waves of Covid-19 infections. The first wave, from mid-2020 to around September of that year, was caused by the original variant. It was when doctors were figuring our treatments, and the guidelines changed frequently. Testing increased from just one laboratory in Pune to hundreds of centres across the country.
The second wave in April-May 2021 saw a large number of cases and deaths over a short period. The surge was driven by the Delta variant that led to deep lung impact and resulted in hospitals overflowing with people in need of oxygen and ventilator support. There was a shortage of medical oxygen.
The third wave, driven by the Omicron variant, was smaller both in terms of number of cases and hospitalisations and deaths. 21 lakh cases reported in a week at the peak in mid-January 2022, but deaths were only about 7,800.
India has since seen ups and downs in the number of cases, but no wave across the country. Hospitals and health systems have been kept ready. Testing and genomic sequencing have been carried out continuously to monitor the situation.
Cases increased through April, with over 12,000 cases reported in a day. The numbers have, however, started going down again — only 3,611 new cases were reported across the country on Friday.
Practical Impact on Global Collaboration and Response and on people
The classification of a health threat as a global emergency is meant to warn political authorities that there is an “extraordinary” event that could constitute a health threat to other countries and requires a coordinated response to contain it. WHO’s emergency declarations are typically used as an international SOS for countries who need help. They can also spur countries to introduce special measures to combat disease or release extra funds. Declaring COVID-19 a PHEIC signalled the need for coordinated global action to protect people from the new virus.
Following the end of the emergency phase, it will now be up to individual countries to continue to manage COVID-19 in the way they think best. The move is likely to usher the world into a new phase of disease monitoring with a scaling back of surveillance and available resources to fight COVID-19.
When the PHE ends, government agencies in many countries will no longer be able to compel testing laboratories to report their COVID-19 test results, or states to report numbers of vaccinations. The agencies’ collection and publication of aggregate data—the total number of cases in a jurisdiction—will also end. Case numbers and test positivity levels, the percentage of positive tests among all tests taken, will no longer appear on government dashboards and data tracker.
While the end of the COVID-19 emergency brings positive developments in terms of the pandemic’s control and management, it may also have some potential negative impacts on surveillance efforts. These negative impacts can include the following:
Decreased Prioritization: As the immediate crisis subsides and the emergency status is lifted, there is a risk that surveillance activities related to COVID-19 may receive less attention and funding. With competing priorities and limited resources, governments and health agencies may shift their focus away from surveillance efforts, potentially leading to reduced resources allocated to surveillance systems, decreased testing and monitoring, and a relaxation of contact-tracing and reporting requirements.
Complacency and Reduced Vigilance: The end of the emergency declaration might create a perception that the threat of COVID-19 has diminished significantly. This could lead to complacency among the public, healthcare providers, and policymakers, resulting in a decrease in adherence to public health measures and a decreased sense of urgency in maintaining robust surveillance systems.
Variants and Surveillance Gaps: The emergence and spread of new variants of the SARS-CoV-2 virus pose ongoing challenges to public health surveillance. While the end of the emergency does not eliminate the need for variant surveillance, a reduction in resources and attention could hinder the ability to detect and monitor emerging variants effectively. Surveillance gaps could emerge, making it more difficult to identify and track the spread of new variants, which may have implications for public health strategies, treatment effectiveness, and vaccine development.
Weakened International Collaboration: The end of the COVID-19 emergency may result in a reduced sense of urgency for international collaboration and data sharing. During the emergency, there was an increased focus on global cooperation and the exchange of information and resources. However, as the crisis abates, countries may be less inclined to prioritize international collaboration in surveillance efforts, leading to potential gaps in data sharing, slower identification of emerging trends, and reduced cooperation in addressing cross-border challenges.
Resource Reallocation: The financial and human resources that were initially allocated to COVID-19 surveillance may be redirected to other pressing public health needs or priorities as the emergency ends. This reallocation of resources may result in a decreased capacity for robust surveillance systems, including testing, contact tracing, data collection, and analysis.
Although it is unclear whether this decision will have much of an impact, given that many countries have already been relaxing measures to combat COVID-19 and experts believe that the decision to end the PHIED is pragmatic and reasonable, they also worry about the effects on resources and the availability of diagnostic tests, vaccinations and treatments.
The risks the WHO committee debated included that a new variant could take the world by surprise, that ending the PHEIC could be misinterpreted by countries and lead them to lower their guard, and that access to vaccines could be hampered. But those risks had to be balanced with a realistic picture of the pandemic as the number of weekly reported deaths for each of the past 10 weeks has been the lowest since March 2020.
There are no lockdowns; international travel, restaurants, and cinemas are normal; and containment and control measures haven’t been needed for some time now. So, not much will change on ground with the WHO declaration. However, health officials say the virus isn’t going anywhere and advise people to get vaccinated, including getting booster doses if they qualify. Although many of the measures seen at the height of the pandemic, including masks and social distancing, aren’t required except in certain settings, like hospitals or nursing homes, officials say people with other health conditions or compromised immune systems may still want to continue with some of those precautions. Unlike in the early years of COVID-19, high immunization levels, both from vaccination and previous infection, have helped dramatically reduce disease spread.
The path forward
Thousands of people worldwide are still undergoing treatment for COVID-19 in intensive care units, and millions are grappling with long-term effects of the infection. Despite progress, the World Health Organization (WHO) continues to receive reports of thousands of deaths each week, with some estimates indicating a global excess mortality rate of approximately 10,000 deaths per day.
It is crucial to emphasize that the removal of the highest level of alert does not signify the end of the danger posed by COVID-19. The emergency status could be reinstated if the situation changes. The WHO chief has emphasized that countries must not interpret this news as a reason to lower their guard, dismantle established systems, or convey the message that COVID-19 is not a concern. Vigilance and precautionary measures remain essential.
In recognition of the ongoing challenges, the WHO has established a review committee tasked with developing long-term recommendations for countries on managing COVID-19. Additionally, the organization recently published an updated version of its strategic preparedness and response plan for COVID-19, outlining actions that countries should undertake over the next two years.
Surveillance efforts should now focus primarily on identifying dangerous and disruptive variants of the virus, particularly those leading to hospitalizations. Community-level surveillance can be conducted through wastewater analysis and the detection of clusters. Moreover, it is crucial to acknowledge that population immunity is waning. While universal vaccination is no longer mandatory, it may be prudent to consider prioritizing vaccinations for elderly individuals and those with comorbidities as immunity declines. Additionally, individuals at high risk should continue to wear masks in crowded and poorly ventilated spaces as a precautionary measure.
It is important for governments, healthcare systems, and individuals to remain vigilant, adapt to changing circumstances, and uphold necessary measures to prevent the further spread of COVID-19.
References:
https://www.nature.com/articles/d41586-023-01559-z
https://www.bbc.com/news/health-65499929
https://www.science.org/content/article/who-ends-pandemic-emergency-covid-19-deaths-fall
https://www.npr.org/sections/goatsandsoda
Photo Credits: Andres Barrionuevo Lopez / iStock