The World Health Organization announced Friday that it was ending the emergency it declared for covid-19 more than three years ago, a milestone in the fitful emergence from a pandemic that has killed millions of people around the world and upended daily life in previously unimaginable ways.
"It is with great hope that I declare covid-19 over as a global health emergency," said the WHO director-general, Tedros Adhanom Ghebreyesus.
In the United States, the public health emergency is set to end Thursday, and yet the White House recently received a sobering warning about the potential for the coronavirus to come roaring back, with experts reaching a consensus that there's a roughly 20% chance during the next two years of an outbreak rivaling the onslaught of illness inflicted by the omicron variant.
A forecast from one widely regarded scientist pegged the risk at a more alarming level, suggesting a 40% chance of an omicron-like wave.
WHO officials did warn that the decision to lift the global emergency does not signal an end to the pandemic, and they cautioned countries not to take this as reason to dismantle covid response systems. Dr. Maria Van Kerkhove, the WHO technical lead on covid, said the organization wanted to be as clear as possible knowing that people would wonder how to think about the pandemic going forward.
"The emergency phase is over, but covid is not," she said.
White House officials spoke with about a dozen leading experts in virology, immunobiology and other fields about the prospect that the virus would again develop mutations that allow it to evade protections from vaccines and treatments.
Some experts based their conclusions on existing research, and at least one, computational biologist Trevor Bedford of the Fred Hutchinson Cancer Center in Seattle, conducted new statistical analysis about the potential for a coronavirus wave.
"No one's saying it's zero. No one's saying it's 80%," said Dan Barouch, an immunologist and virologist at Harvard Medical School, who spoke with the White House. "It's more than an infinitesimal chance -- and it is by no means a certainty."
The experts' analysis was shared in a report among Biden administration leaders this spring as they weighed how to wind down their coronavirus response team and set up initiatives intended to provide longer-term pandemic protections.
Several of those initiatives -- including a next-generation vaccine program and a program to cover coronavirus vaccines and covid treatments for the uninsured -- are at risk as Republicans seek to claw back unspent coronavirus funds as part of ongoing debt ceiling talks in Congress.
The White House declined to comment about the experts' analysis.
"The administration has conversations with a broad range of experts, both inside and outside of government, on a number of issues," a White House spokesperson said in an email.
Senior officials have publicly emphasized the need to implement more public health protections to guard against the next viral threat, even as political will and funding fades along with the threat from the coronavirus.
"One of my biggest worries is that we are losing time in preparing for the next pandemic," Dawn O'Connell, assistant secretary for preparedness and response at the Department of Health and Human Services, told a Senate committee Thursday.
Rochelle Walensky, the Centers for Disease Control and Prevention director who announced Friday that she was stepping down, also warned the Senate panel that her agency still faces challenges such as limitations on collecting data from hospitals and local health departments about potential outbreaks.
"We can't act swiftly, nimbly, robustly if we can't see what is happening from a data standpoint," Walensky said.
Indeed, in practical terms, the decision to end the emergency changes little.
Many countries have already ended their own states of emergency and have moved away from almost all public health restrictions implemented to control the virus. But the lifting of the WHO designation -- officially called a "public health emergency of international concern" -- is a significant moment in the evolving human relationship with the novel coronavirus.
Dr. K. Srinath Reddy, who led India's Public Health Foundation through the pandemic, said the decision to lift the emergency was appropriate, because of the high levels globally of immunity to covid induced by vaccination or infection, or both.
"It no longer possesses the same level of danger," he said, adding that covid "has achieved a level of equilibrium, a certain type of coexistence with the human host."
Reddy said the end of the emergency status should also be appreciated as a moment of human achievement and a "celebration of science."
"It's important to recognize that what made the virus change its character is not only evolutionary biology," he said, "but also the fact that we have induced it to actually become less virulent, by vaccination, by masks, by a number of public health measures."
In the short term, the White House coronavirus response is facing a bigger threat than a theoretical virus variant: Washington budget talks.
The GOP-led House last week passed debt ceiling legislation that would rescind unspent funding set aside for the coronavirus response -- a total that some estimate is more than $50 billion.
"Billions of dollars sitting out there [for] covid, never spent, just sitting there. We claw that back so the American taxpayer can save the money," House Speaker Kevin McCarthy, R-Calif., said last week on Fox News.
House Democrats counter that the remaining coronavirus funds are necessary to prepare for future pandemics and to fortify the nation's public health system.
For instance, rescinding the $5 billion set aside for the next-generation vaccine program "would eliminate advanced research and development of vaccines and therapeutics to combat future covid variants, including intranasal vaccines that could prevent new respiratory infections and 'universal' vaccines that could provide protection against all coronaviruses," Democrats warned last month in a fact sheet.
Marc Goldwein, senior vice president at the Committee for a Responsible Federal Budget, a nonpartisan fiscal watchdog, said he supported efforts to reclaim some of that money for other purposes.
"If there is any money the administration actually needs but hasn't obligated -- for example to make sure we have good covid vaccines -- the burden is on them at this point to explain why that money shouldn't be rescinded," Goldwein wrote in an email.
The Biden administration, through a health agency known as the Biomedical Advanced Research and Development Authority, has begun seeking industry partners for its next-generation coronavirus vaccines and treatments initiative.
Tom Inglesby, director of the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health and former coronavirus testing coordinator for the Biden administration, argued that longer-lasting, more protective vaccines are needed to blunt future virus surges.
"Rescinding money for covid response would be a mistake," Inglesby wrote in a text message. "The country is in such a different, better place now on covid, but this disease is not gone -- there are still 150 Americans dying of covid every day."
Fewer than 80,000 confirmed coronavirus cases were reported across the United States last week -- the lowest figure since March 2020. But the actual rate of infection is almost certainly far higher than the reported numbers, with many Americans testing at home, if at all, and opting not to report their results.
The potential for large indoor gatherings to fuel coronavirus infections remains high, as illustrated by about three dozen cases linked to a CDC conference last week. The virus remains on pace to be one of the top 10 causes of death this year, with fatalities concentrated among older and immunocompromised individuals.
"What most people don't understand ... this virus isn't going away," said Eric Topol, director of the Scripps Research Translational Institute, who also spoke with the White House about its covid projections.
In Little Rock, then-Arkansas Gov. Asa Hutchinson declared a statewide public health emergency on March 11, 2020, the same day the state's first covid-19 case was diagnosed.
That declaration expired in May 2021 after vaccines had become available to the general public. Another emergency declaration was in place for two months during a surge of cases that summer.
Days after taking office in January, Gov. Sarah Huckabee Sanders announced that she had disbanded five covid-19 pandemic groups and committees that were established under Hutchinson's administration.
"Unfortunately, government has prioritized covid-19 disproportionally and allowed other health concerns like addiction, cancer screenings, diabetes and mental health to worsen," Sanders said at the time. "As governor, I will always put the health, safety and well-being of Arkansans first."
In February, the total number of cases in Arkansas since 2020 topped 1 million, according to state Department of Health figures at the time. As of Friday, however, the Health Department and U.S. Centers for Disease Control and Prevention websites put the number at 994,386.
Information on the reason for the discrepancy wasn't available Friday from the Health Department.
The department also reported 13,115 deaths from the virus, including 297 so far this year. By comparison, a total of 5,258 deaths were reported for the state in 2021 and 3,407 in 2022.
The virus was the most dangerous for elderly patients. Of those Arkansans who died from covid, 74.6% were 65 and older.
In March, the Health Department stopped providing daily updates on the state's cases, deaths and hospitalizations from covid-19, switching to weekly updates instead.
Department spokeswoman Danyelle McNeill said Fridaythat the department will continue to offer covid tests and vaccinations at no cost to the patient. Insurance companies will be billed for those patients who have coverage, but those who are uninsured or underinsured will still be able to get tested and vaccinated without any out-of-pocket cost, she said.
TOLL EVEN HIGHER
Globally, there have been 765,222,932 confirmed cases of covid, including 6,921,614 deaths, reported to the WHO as of May 3. But these figures are a vast undercount of the pandemic's true toll.
"We know the true toll is several times higher, at least 20 million," Tedros said.
A year ago, the WHO said 15 million more people had died in the first two years of the pandemic than would have in normal times, a figure that laid bare how vastly countries had undercounted victims. Developing nations bore the brunt of the devastation, with nearly 8 million more people than expected dying in lower- to middle-income nations by the end of 2021.
"Covid-19 has been so much more than a health crisis," Tedros said.
"Covid-19 exposed and exacerbated political fault lines within and between nations," he said. "It has eroded trust between people, governments and institutions fueled by a torrent of myths and misinformation. It has laid bare the searing inequalities of our world, with the poorest and most vulnerable communities the hardest hit and the last to receive access to vaccines and other tools."
The WHO leaders who addressed the media about the ending of the emergency described the moment as an emotional one.
"It didn't have to be this way," Van Kerkhove said, also noting that the virus continues to spread.
The WHO recorded 2.8 million new cases globally, and more than 17,000 deaths, from April 3-30, the most recent numbers available. As many countries have reduced their testing, these numbers also probably represent a significant undercount.
The WHO's emergency declaration was a crucial piece of guidance when it was made Jan. 30, 2020, when just 213 people were known to have died of the virus. It gave countries critical buttressing to impose potentially unpopular or disruptive public health measures.
Dr. Githinji Gitahi, executive director of Amref Health Africa, said it was time to lift the emergency.
"The danger of keeping it forever is diluting the tool -- you need it to retain its force," he said. The declaration helped to mobilize resources for Africa, he said, but did nothing to counter the bleak experience of what he called "vaccine injustice."
Amref continues to work on supporting vaccination in 35 African countries; continentwide, coverage now stands at 52%.
The pandemic also has a positive legacy, Gitahi said, because it spurred the highest level of cooperation ever seen among African countries, including the creation of an African Union task force to coordinate procurement of vaccines. The covid response has led to increased capacity and investment in many African countries in areas such as genomic sequencing and disease surveillance.
The WHO decision was not welcomed by all health experts. Dr. Margareth Dalcolmo -- a respiratory physician and member of Brazil's National Academy of Medicine who was one of that country's most prominent experts guiding the public through the pandemic -- said it was too soon to lift the emergency, given that there are still urgent tasks such as research into covid variants and development of multivalent vaccines. The designation of global public health emergency also creates leverage for lower-income nations to access treatments and support, she said.
Dalcolmo said the lifting of the global emergency should be viewed not as a milestone but as a warning.
Information for this article was contributed by Tony Holt of the Arkansas Democrat-Gazette, by Stephanie Nolen of The New York Times and by Dan Diamond of The Washington Post.