The Covid pandemic still isn’t over, but it has gone remarkably flat.
It’s been nearly a year since Omicron was discovered in South Africa and Botswana, and no new variant of concern has been declared since then by the World Health Organization. That’s a notable interlude, since five were declared in the previous year.
There have been plenty of new variants of Omicron, of course — so many lineages that all but the most conscientious or neurotic Americans have probably lost track of them. And each new subvariant (XBB, BQ.1 and BQ.1.1, to name three recent ones of note) has produced a small flurry of worried coverage about immune evasion and transmissibility, with some producing small surges in infection as well.
But all of them are part of the same family, and though some are quite distant relatives of the original Omicron subvariant, none have meaningfully changed the big-picture story of the disease. The third anniversary of the pandemic is around the corner, and we remain in the quasi-endemic steady state that has characterized things since the early spring: Infections are very common, and deaths are distressingly high, but without another Omicron, new subvariants really don’t seem to matter all that much.
Even just a few weeks ago, there was some worry about what these new Scrabble variants might mean, and some alarms flashed abroad. In Britain, where we often look first for bad Covid news coming down the pike, infections and hospitalizations suddenly took a turn for the worse. In Germany, hospitalizations for Covid reached a pandemic high. There was rapid case growth in Singapore as well.
But pretty quickly, the tide turned, making the ultimate impact of the new subvariants hard to see unless you were squinting. The British hospitalization charts turned a corner, the German hospitalization rate dropped in half over the course of October, and the Singapore case surge declined without generating an equivalent surge in deaths. In India and Bangladesh, the new subvariants took over without producing a visible surge in cases or deaths. In many of these cases, the new subvariants presumably drove the small waves of infection. But those surges stayed small, in spite of limited mitigation measures, namely because of the accumulated protection of natural and vaccine-generated immunity.
As recently as a month or so ago, close observers of the pandemic were watching eagle-eyed for the early trajectories of these new subvariants, talking in arcane language about immune evasion and transmission advantages as though the new subvariants could signal large breaks in our experience of it. Now it looks as if some of those indicators don’t suggest very much. The virus is still evolving, but recent changes don’t seem to be much of a match for the immunological state of play. In the United States, the Scrabble variants account for a majority of infections, and yet the number of hospitalizations and deaths have remained flat.
Given the panicked tumult of the first two years of the pandemic, this recent continuity has been remarkable: Since mid-April, the number of average daily deaths in the United States has held close to constant; aside from one week at the beginning of June, it has been 300 to 500 each day for more than six months. There was a hospitalization surge in midsummer, but even at its peak, the numbers stayed below the levels of most of the first 24 months of the pandemic. The worst period of hospitalizations in the past six months was still better than any other period from the preceding two years, with the exception of the hot vax summer in 2021. I.C.U. admissions also surged but remained lower than at any other point during the pandemic, outside of a couple of weeks that summer.
There were local surges, of course: You could see it in the wastewater in Boston in early October or in the number of hospitalizations in New York State in late October. And since it is only early November, the country is not yet out of the seasonality woods yet — far from it. But with no new variant of concern on the horizon, it seems unlikely that any seasonal surge will produce anything approaching the experience of the past two winters, and it’s much more likely that the next few months will unfold like the previous six, however temperate.
Where does that leave us? In early July, the demographer Lyman Stone looked at the country’s excess mortality data and declared “the pandemic in the United States appears to finally truly be over.” Excess mortality is a useful metric for taking the full measure of the pandemic, since it is not affected by local variation in testing and accounts for those who might have died not from Covid but because of social and health care disruptions. “Since 2020 my line has been that once we have 2-3 months of zero excess mortality, then we can say we’re really through it,” Stone explained in a tweet. “Well, April-June appear to have had virtually zero excess mortality. We’re really through it.”
Around the same time, I wrote about the uncomfortable quasi-endemic plateau, and so I followed Stone’s proclamation with real interest, hoping that he was right and I’d been wrong. But while Covid’s impact on excess mortality has been subdued in the months since, compared with the roller coaster panics of the previous two years, it has not entirely subsided.
What Stone observed in April, May and June, it now seems, was not the end of the pandemic so much as the aftermath of the initial Omicron surge, with fewer excess deaths immediately after that brutal wave, in part because so many of the country’s most vulnerable had just died — a phenomenon I’ve heard described by virologists, grimly, as a culling or harvesting effect.
Excess mortality took a similar if shorter dip in March of 2021, in the aftermath of that year’s winter surge, and even fell close to zero briefly in 2020, right after the pandemic’s initial spring wave. According to the Centers for Disease Control and Prevention, the country has experienced an average of about 5,000 excess deaths every week since mid-April. (This amounts to weekly excesses of expected mortality of 5 to 10 percent, compared with 35 or even 40 percent during each of the previous major surges.) The Economist’s excess mortality data, which uses a slightly different methodology, tells the same story: relatively steady, comparatively little excess mortality since April.
Compared with what, though? Four hundred deaths a day add up to almost 150,000 deaths a year. If we avoid a major surge in the next two months, the Covid death toll for the full year will stay below 300,000. That isn’t quite as horrific as the 350,000 deaths the country registered in 2020 or the 475,000 it registered last year. But it’s still tragic. It’s just normal now, too.
The New York Times
