Twenty-two million deaths later, it’s over. On Friday, the World Health Organization declared the end of the Covid-19 global health emergency. In the United States, the public health emergency will officially be withdrawn next week. For years now, Americans despairing at the death and disruption of the pandemic have found themselves asking, when will it end? The answer, officially, is now, however arbitrary that may seem.
How did we get here? In 2020, we talked about “flattening the curve” and “zero Covid.” We let ourselves imagine that an endgame might arrive soon. We looked at graphs charting the waves of the Spanish flu and wondered how many such waves we might have to endure: Would it be one winter surge or two? We whispered about herd immunity and tried to work out how many would have to be infected before the disease truly receded from our lives: 60 percent? 70 percent? 90 percent? When the vaccines arrived, sooner than almost anyone believed possible, it seemed like a herald of the end. At least for those of us who got the shots. At least for a while.
All of this proved to be wishful thinking — or at the very least, algorithmic, whiteboard thinking that ultimately crashed against real-world surprises. We got new variants, most notably ones that were more transmissible and more effective at evading immunity. And even though we got those miraculous vaccines, we still got breakthrough cases and were forced to learn, death by death, about waning immunity and the enduring risks to the most vulnerable, particularly the elderly.
In the end, these surprises validated some of the scarier projections made by modelers at the beginning of the pandemic. In the United States, Dr. Anthony Fauci warned of a true worst-case scenario of a million American deaths, and today, we’re past 1.1 million; in Britain, Neil Ferguson warned of 250,000 deaths, and today, the total there is upward of 225,000.
But as it turned out, no model could predict with certainty when the pandemic would end. As medical historians suggested almost from the start, that would not be an epidemiological threshold but a social and political decision, probably reached by exhausted consensus more than triumphant unanimity. And so here we are.
But where is that, exactly? In April, according to The Economist’s excess mortality database, there were more than 11,000 additional deaths every day, worldwide, than would have been expected in the absence of the pandemic. This is a pace of about four million excess deaths per year. The proportion of those deaths officially attributed to Covid-19 has been shrinking steadily, and in recent weeks it has been well below 1,000 per day — the lowest level since March 2020 — though presumably in part the result of less aggressive testing and surveillance in much of the world.
Excess mortality tells a somewhat different story. And while it has somewhat flattened over the past year, the trendline over the past few months is not pointing meaningfully downward at the global level.
With a couple of brief exceptions, excess deaths have held steady for about a year now in a range between about 8,000 and 15,000 per day. Over the past 12 months, there have been more than four million excess deaths globally — about as many as were estimated for the first 11 months of 2020. Over the past six months, there have been more than two million excess deaths — about as many as were estimated globally for the first eight months of 2020. At some point we may simply stop referring to these as excess deaths and incorporate them instead into higher mortality baselines.
But as the W.H.O. and the United States declare the end of the pandemic emergency, it is now safe to say that a large majority of people living anywhere on the planet have gotten Covid. In the United States, it has been estimated that 94 percent or more of the public has experienced at least one infection, which may help explain why the country’s official count of Covid deaths finally appears to be falling. Excess mortality, too. Covid is not gone from American life, but thanks to exposure and vaccination, it has genuinely receded in the mortality statistics, falling from a top-three cause of death in each of the first years of the pandemic to, likely, merely a top-10 cause of death this year. And while the long-term impacts on public health aren’t exactly clear, the effects seem to be shrinking there, too — the best estimates of the incidence of long Covid, for instance, are about 40 percent lower for second infections than for initial ones.
Globally, the picture of total exposure is somewhat murkier, thanks to far more patchwork testing regimens. There may still be relatively more immunologically naïve people elsewhere in the world than here in the United States — though not all that many. And while there is good reason to believe that at least three-quarters of the global population has now been infected with a disease that was publicly identified only about 40 months ago, an unconscionably high proportion of the world’s poorest remain unprotected by vaccination.
As of this winter, only 23 percent of people living in low-income countries had been vaccinated, according to the U.N. Development Program. And most of that vaccination came in the past year: When high-income and upper-middle-income countries reached about 70 percent vaccination at the end of 2021, low-income countries were still stuck at 3 percent. This has been called “shot-hoarding” by the world’s wealthiest; a less generous term is “vaccine apartheid.”
Early in the pandemic, it was often said that the poorest countries of the world were faring better than the richest — perhaps to some degree because of resilient public health systems and healthier social structures, but mostly because their populations were so much younger and therefore less vulnerable. But vaccine apartheid reversed those trends. According to an analysis by Philip Schellekens, an economist at the U.N.D.P., though the richest countries fared worst through the first year of the pandemic, by 2023, high-income, upper-middle-income and lower-middle-income countries were all bunched quite closely together in cumulative excess mortality. Low-income countries had roughly two-thirds as much excess mortality in 2022 as in 2021 and have already had as much this year as in all of 2020.
In much of the wealthy world, given lower death rates in an age of mass vaccination, people have mostly moved on from the pandemic emergency already. But it is much harder to see an imminent “end” in sight for the world’s poorest, especially given that the W.H.O. still describes polio — with 800 cases globally last year — as an ongoing emergency.
Overall, globally, the story looks somewhat different — and indeed a bit better. In 2020, there were just under five million excess deaths worldwide, The Economist estimates. In 2021, year two, the figure was just under 10 million. In 2022, year three, a little over six million, and this year, so far, a bit above one million. The line is pointing down, year to year. But it’s still quite far from zero. For now, at least, the endemic phase of Covid remains pretty brutal, however much suffering and disruption and anxiety is in the rearview mirror. And however much of a relief it is to leave the official emergency behind.
David Wallace-Wells (@dwallacewells), a writer for Opinion and a columnist for The New York Times Magazine, is the author of “The Uninhabitable Earth.”
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