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Covid will be a leading cause of death in the U.S. indefinitely, whether or not the pandemic is 'over'

Disease experts predict that Covid will remain among the top 10 causes of death in the U.S. for the foreseeable future.
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After President Joe Biden said the coronavirus pandemic was "over" in an interview Sunday, many people were left wondering how to reconcile his comment with the fact that the U.S. is still averaging about 500 Covid deaths every day.

But disease experts said debating whether the pandemic is over overshadows a more important concern: the reality that Covid will remain a leading cause of death in the U.S. indefinitely.

"It’s likely, when we think of the causes of death in our society, that Covid’s on the list probably forever,” said Dr. Bob Wachter, the chair of the University of California, San Francisco’s department of medicine.

"Whether we call it a pandemic or not, it’s still an important threat to people," he added.

Covid was the third-leading cause of death in the U.S. in 2020, after heart disease and cancer, according to the Centers for Disease Control and Prevention. The same was true last year, provisional CDC data shows. Since April, Covid deaths have stayed relatively flat, at a weekly average of around 300 to 500 per day. If the trend continues, the U.S. could expect 113,000 to 188,000 deaths a year from Covid, putting it on par with Alzheimer’s, chronic lower respiratory diseases and stroke.

Flu, by comparison, kills about 12,000 to 52,000 people annually. Flu and pneumonia combined were the ninth-leading cause of death in 2020; they fell out of the top 10 last year.

"As we’ve figured out how we’re going to live with this disease in perpetuity, it makes sense to contextualize it as another illness that Americans have to face," said Dr. Leana Wen, an emergency physician and professor at George Washington University.

Experts said Covid is likely to remain among the U.S.'s 10 leading causes of death for the foreseeable future, regardless of new vaccines, boosters or treatments that might become available.

Predicting Covid's future death toll

The Institute for Health Metrics and Evaluation, or IHME, a research organization at the University of Washington that regularly models Covid deaths, predicts a decline in Covid deaths over the next two months.

So some experts are hopeful that Covid could drop in the U.S. cause-of-death rankings over time.

"It would not surprise me if we have a similar magnitude of deaths from Covid as we do from flu," said Dr. Chris Murray, the director of the IHME.

Covid death numbers could also fall if hospitals stop routinely testing people for the virus. That's because the current death counts may include some people who tested positive for Covid when they were hospitalized but died of other illnesses.

"Having filled out hundreds of death certificates in my life, I know that some of these deaths are 'with' rather than 'from' Covid," Wachter said.

Murray estimated that half of annual Covid deaths may fall into that category.

The IHME model predicts a steeper drop in deaths this year if 80% of the public wears masks. Wachter said the country could also lower the death count to "half of what it is today" if more people took advantage of vaccines, boosters or treatments.

The White House coronavirus response coordinator, Dr. Ashish Jha, has said he thinks those measures could lead the number to drop further: "We now have all of the capability to prevent, I believe, essentially all of those deaths," he said at a briefing this month.

But at this point, Murray said, "most people have moved on" in terms of their behavior.

But ... is the pandemic over or not?

Many disease experts think it’s time, or almost time, to declare an end to the pandemic, given the widespread availability of Covid vaccines and treatments, the fact that no variant has overtaken omicron since December and the relatively stable U.S. case and death counts over the last few months.

Image: Funeral homes in NYC overwhelmed by COVID-19 death
Caskets holding the bodies of people who died from Covid-19 at the Gerard J. Neufeld funeral home in Queens, N.Y., on April 29, 2020.Tayfun Coskun / Anadolu Agency via Getty Images

"If you believe, as I do, that we have reached a new stage of stability, to continue to call it a pandemic purely for the purpose of trying to scare people into doing stuff doesn’t seem right to me," Wachter said.

World Health Organization Director-General Tedros Adhanom Ghebreyesus struck a similar chord last week, suggesting that the end of the pandemic was "in sight."

White House officials, too, said this month that the new omicron-specific boosters marked a shift in the pandemic. Covid shots are likely to become annual affairs, with a schedule resembling that of flu shots, the officials said.

"They are feeling like we have to shift our mindset to the long game here," Wachter said of the White House's response. "This is no longer an acute threat in the same way it was.”

But other experts think the pandemic phase is very much ongoing.

"If we were to see the number of deaths from Covid down to what we see on an annual basis for flu — somewhere in the 20,000-a-year range — we’ll then say that the pandemic is clearly over," said Dr. Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health.

Rachael Piltch-Loeb, a research associate at the Harvard T.H. Chan School of Public Health, said that in declaring the pandemic over now, it "seems like we are endorsing this level of disease burden and mortality associated with the virus."

And Dr. Kavita Patel, a primary care physician who was a policy adviser during the Obama administration, said the virus has to become more predictable before the pandemic can be considered over.

"We need to have some regular patterns, kind of like the flu, so that we can expect certain timing for sickness, certain timing for hospitalizations," she said. Given that's not the case, Patel said, she found Biden’s declaration "a bit disturbing to hear."

After Biden’s comments, a White House official said that the president was speaking about the pandemic in a plain manner and that his remarks mirrored what many people think about Covid today. 

Whether the remarks discourage people from getting the updated bivalent booster shots remains to be seen. Piltch-Loeb doesn't expect Biden's statement to change many minds.

"Folks who don’t want to get this booster already think that the pandemic is over," she said.