5 years after COVID-19 became a pandemic, are we ready for what’s next?
“Whether the pandemic ended or not is an intellectual debate,” says clinical epidemiologist and long COVID researcher Ziyad Al-Aly of Washington University in St. Louis. “For the family that lost a loved one a week ago in the ICU, that threat is real. That pain is real. That loss is real.”
According to recent WHO data, 521 people in the United States died of COVID-19 in the last week of 2024. That’s drastically lower than at the height of the pandemic in 2020. Nearly 17,000 people died of COVID-19 the last week of that year.
Dropping death and hospitalization rates, largely due to vaccinations and high levels of immunity, led to WHO and the United States ending their COVID-19 public health emergencies in 2023. The U.S. government has since reduced reporting of infections and access to free vaccines, tests and treatments. In the last two years, health professionals, scientists and policymakers have shifted to managing COVID-19 as an endemic disease, one that’s always present and may surge at certain times of the year.
Over the last five years, researchers have learned heaps about the virus and how to thwart it. But the pandemic also provided insights into health inequities, flaws in health care systems and the power of collaboration. But it’s hard to predict how the United States and other countries will manage COVID-19 going forward, let alone future pandemics.
To get a sense of scientists’ current understanding of COVID-19 and what’s at stake, Science News spoke with Al-Aly, infectious disease physician Peter Chin-Hong of the University of California, San Francisco Health, and epidemiologist Bill Hanage of the Harvard T.H. Chan School of Public Health in Boston. The conversations have been edited for length and clarity.
What have scientists learned about COVID-19 since the pandemic began?
Al-Aly: We learned it’s an airborne virus. We learned that, unfortunately, it was [and still can be] fatal. More than 1 million Americans lost their lives. We also learned that it resulted in a wave of chronic disease and disability. There are now more than 20 million Americans living with long COVID.
Chin-Hong: We’ve learned the genetic sequence of COVID. We’ve developed vaccines, including mRNA vaccines that hadn’t been used on a wide scale before. We’ve developed tests, particularly tests at home, which hadn’t been the favorite strategy of the U.S. Food and Drug Administration before this pandemic.
Hanage: We’ve learned that a virus can transform itself, such that you get waves of infections like the omicron wave. We also had a lesson that the folk evolutionary biology saying, “viruses don’t want to kill you, they will evolve to become nicer over time,” is false. The alpha variant was somewhat more dangerous than the original strain, and the delta variant was somewhat more dangerous than the alpha variant.
We suspected quite early on that, given many people could be shedding virus without very severe symptoms, this was likely to be [something that spreads] like wildfire before anybody knew they were sick. The things that are most societally damaging are … the ones that people don’t notice until tens of thousands are infected.
How is COVID-19 being monitored now in the United States?
Hanage: There’s still reasonably active genomic surveillance, trying to figure out whether the virus is going to make another of those leaps and which leap is going to herald an unusually large surge of infections.
Chin-Hong: What’s actively monitoring [COVID-19 infections] is wastewater. We can’t tell what number of individuals [in a community are infected, but] we know what variants are circulating.
Deaths and hospitalizations are still being monitored, although hospitals aren’t obligated to report data centrally anymore.
What do we know about long COVID-19 at this point?
Al-Aly: It affects at least 400 million lives across the globe. We recently estimated the economic losses to be about $1 trillion per year. That’s about 1 percent of global productivity.
Long COVID can affect nearly every organ system. People think about it [as causing] brain frog and fatigue. Those can be symptoms of long COVID, but it’s much more than that. We have people with heart problems, kidney problems and metabolic problems. In some individuals, long COVID can be mild and not disabling. But in others, it can be severely disabling, to the point of people being in bed and losing their jobs.
Unfortunately, we haven’t really cracked the code for treating long COVID. There are still no established treatments approved by the FDA.
How has COVID-19 management changed now that the virus is considered endemic?
Chin-Hong: I think the biggest shift is thinking about respiratory viruses together, because they do travel as a pack. Many of them appear in similar ways and at similar times of the year. But they are also prevented in similar ways, for example, by wearing a mask or getting a vaccine.
There is some danger in forgetting about COVID, specifically. It’s still causing a significant number of deaths, although much lower than early in the pandemic.
Hanage: [Ending the public health emergency] has led to shifts in funding. The funds that people were expecting to have, in some cases, have been withdrawn or become more uncertain. That happened during the Biden administration, and it’s going to become even more [uncertain] under the current one.
Researchers are looking at longer-term questions. We still have quite a lot to learn about the ways in which SARS-CoV-2 interacts with the immune system, different cells and so on. They matter for devising things like potential treatments for long COVID or antivirals.
The United States is withdrawing from the World Health Organization. How might that affect COVID-19 management?
Chin-Hong: Number one is resources. The WHO is funded by many countries, but the United States provides the lion’s share, so the withdrawal will limit the management of world health in general. Number two is siloing — you can’t see the whole picture [of global health]. The third is the appearance that the United States is not part of a global network.
Are we any better prepared for potential future pandemics?
Chin-Hong: I think we’re prepared in some ways and not prepared in others. The ways that we’re prepared are really in bringing technology from the bench to the bedside.
Some of the biggest threats are people being fatigued with COVID [news] and the amount of misinformation and disinformation.
Al-Aly: No, I think it’s the reverse. We’re even more ill-prepared and in a worse situation because we politicized COVID: vaccines, treatments, masks. We politicized every single pandemic response.
If a pandemic breaks out in March 2025, I predict that vaccine uptake would be way less than it was for COVID-19, and there would be less enthusiasm for masking and a lot of the public health measures that protected millions of people in the U.S.
Does anything that’s happened during this pandemic give you hope for the future?
Al-Aly: Operation Warp Speed was a human feat. We as a community of scientists, under the leadership of President Trump, marshalled resources and realized vaccine development in record speed.
Scientists across the globe dropped everything they were doing and said, “Okay, we’re going to focus on long COVID.” There’s no other condition that, within the span of five years, we have this many academic publications — about 40,000 and counting.
Then, really the patient community that led the way. Patients with long COVID helped us understand that long COVID is happening, alerted the medical community and guided us in every step of the way in understanding long COVID.
Hanage: We saved lives not only by vaccination, but by the people who voluntarily limited their contacts, were caring enough to stay home if they felt sick, [and did] not prioritize themselves over the risks to the people they lived alongside.
