Emerging from the COVID pandemic, again

The shift was palpable after several failed re-opening attempts in many countries. The arrival of the Omicron variant in late 2021, with its ability to re-infect people and the record spike in COVID cases that followed, initially stoked scientists' worst fears and confounded predictions for a return to normalcy.

Yet in the ensuing months, a more stable scenario played out. Emerging variations of the coronavirus so far remain closely related to Omicron, without radically altering its impact.

Vaccination is largely protective against severe disease and death for many people, and a new generation of booster shots targeting Omicron variants was introduced. The medical community also has an improved arsenal of treatments for those who fall ill.

"It's almost as though the virus has somehow gotten stuck in this evolutionary valley," said Dr. Daniel Kuritzkes, chief of infectious diseases at Brigham and Women's Hospital in Boston. "Fortunately, no dramatically different variant has emerged."

As a result, in many places, masks came off, schools resumed in-person classes, holiday travel and large celebrations became possible once again. "The pandemic is over," U.S. President Joe Biden said in September, referring to the changing behavior of Americans.

Global health officials cautioned the public against letting its guard down, while acknowledging a change in outlook nearly three years after the virus was first detected. The World Health Organization (WHO) has yet to declare an end to the COVID public health emergency introduced in January 2020.

"We are not there yet. But the end is in sight," WHO Director-General Tedros Adhanom Ghebreyesus told reporters shortly after Biden's remarks in September.

While the most acute threat of COVID has receded in many places, it continues to loom large in everyday life.

Nearly seven million people have died of the illness, with global daily deaths remaining close to 2,000. New outbreaks continue to sideline people from work and school, and the risk of long COVID - debilitating symptoms that can last for months - appears to increase with repeat infection. Access to vaccines, booster shots and treatments remains unequal globally.

In China, a zero-COVID policy has kept deaths to a minimum and spared its healthcare system from collapsing under a surge in infections.

But a significant proportion of the country's 1.4 billion population may not have been exposed to the virus, preventing development of natural immunity which, alongside high vaccination rates, creates protection. The policy has required large-scale lockdowns that have proven increasingly intolerable to the public.

For many experts, 2023 will bring COVID's full impact on global health into sharp focus.

Data show that the pandemic has disrupted all kinds of healthcare, from childhood immunizations to cancer screenings. Life expectancy in some countries has fallen, while mental health concerns have skyrocketed. And the impacts of long COVID are just being recognized, while gaps in national healthcare systems have been exposed as never before.

The question, experts say, is whether these changes will persist, and what kind of policies can be implemented in response. The WHO and its member nations are hashing out a pandemic treaty to govern a better response to future outbreaks.

COVID will continue to require vigilance for people with comprised immune systems, and more broadly when cases surge in a particular location. In such instances, people should consider putting masks back on in crowded places and should stay up to date on available vaccinations.

Infectious disease experts remain on alert for a new coronavirus variant that could dramatically undermine vaccines and treatments.

Gaps in COVID testing and vaccination rates "are continuing to create the perfect conditions for a new variant of concern to emerge that could cause significant mortality," Tedros said last week.