John Ioannidis, a Professor of Medicine, of Epidemiology and Population Health and by courtesy, of Statistics and of Biomedical Data Science at Stanford University, lauded for championing evidence-based medicine, has been harshly criticized over the past two years. Like many highly-credentialed health experts, Ioannidis made some predictions during the pandemic that eventually proved to be incorrect. During a once-in-a-century pandemic replete with unknowns, that's to be expected. But perhaps the greatest reason he has come under fire is for questioning the orthodoxy of strict lockdowns, divisive vaccine mandates, and other restrictive measures to manage the pandemic. Ioannidis is sure to court more controversy with a new commentary published to the European Journal of Clinicial Investigation in which he argues that it's time to declare the end of the COVID-19 pandemic.
"This does not mean that the problem is inappropriately minimized or forgotten, but that our communities move on with life," he writes.
"Pandemic preparedness should be carefully thought and pre-organized, but should not disrupt life."
While Ioannidis recognizes that there are no quantitative definitions for the end of a pandemic like COVID-19, he contends that the amount of immunity now present worldwide exceeds the threshold needed to declare SARS-CoV-2, the virus that causes COVID-19, endemic – constantly present but not a public health emergency.
"By end 2021, probably 73-81% of the global population had been vaccinated, infected or both," he says. Pockets of low immunity, such as in places that pursued zero-COVID policies and/or with limited access to effective vaccines, may persist, causing regional outbreaks, but we will likely never see COVID-19 again trigger a global emergency.
Declaring the pandemic phase of COVID-19 to be concluded means understanding and accepting a new "normal".
"A decrease of COVID-19 deaths back to typical seasonal influenza levels may not necessarily happen in 2022 or even beyond," Ioannidis cautions. "With an increasingly aging global population, "normal" may still correspond to higher death counts... This should not be mistaken as a continued pandemic phase."
Easing out of the pandemic requires a widespread mental shift, as well. This means focusing more on indicators like hospital intensive care admissions to guide policy rather than just infections.
"If perception of risk focuses on number of documented cases, the spurious perception of emergency situations may be difficult to quell," Ioannidis writes.
Exiting the pandemic also means reducing fearmongering coverage of COVID-19 in the popular media, the propagation of which undoubtedly contributed to the public's warped perception of COVID's risks throughout the pandemic. On average, Americans believed in early 2021 that 8% of deaths had occurred in people under the age of 24. The actual percentage as of today is 0.3%. Moreover, a third of the population has consistently believed that COVID leads to hospitalization in over half of infections. During the most recent Omicron wave, the proportion was 3% or lower.
Declaring an end to the pandemic phase of COVID-19 has benefits, Ioannidis says. For example, it could allow public health organizations to refocus their time and money on more pressing global health issues, like poor nutrition and hunger, which collectively claim the lives of 9 million people each year, including 3.1 million children. For comparison, at least 6.2 million people have died from COVID-19 over the past two years, the vast majority over age 65. Accepting endemicity and reducing societal restrictions and disruptions would also permit economies to stabilize more rapidly, alleviating hardship, easing inflation, and reducing global inequality. Lastly, moving on from the pandemic could ease some of the political divisions that have fractured societies across the globe.