The pandemic isn't over, the next one is waiting in the wings, and other bad news.

The experts are warning us that ending the "emergency" doesn't end the pandemic, which continues to take thousands of lives. Meanwhile warnings of new pandemics are barely being heard.

Miniature by Pierart dou Tielt illustrating the Tractatus quartus bu Gilles li Muisit (Tournai, c. 1353). The people of Tournai bury victims of the Black Death/ Wikimedia Commons

When the World Health Organization first declared Covid-19 a global emergency on Jan. 30, 2020, just over 200 people had died from the novel coronavirus.

Between April 3 and April 30, 2023, the WHO recorded 2.8 million new cases of Covid-19 around the world, and more than 17,000 deaths. In the United States during the same period, the Centers for Disease Control and Prevention (CDC) logged about 300,000 new cases and 4,400 deaths. The real numbers are likely higher. 

Nevertheless, on May 5, the WHO declared that the global health emergency for the Covid-19 pandemic was over. On May 11, the emergency also will end in the United States.

If it seems as if the goalposts for what constitutes a global health emergency have moved over the past three plus years, they have. A growing acceptance of high mortality numbers is just one of many ways the pandemic changed our lives.

While health officials made it clear the pandemic is far from over — millions of new cases and thousands of deaths are likely to continue for months and years to come — for many of us, especially in the wealthy West, the combination of vaccines and natural immunity has allowed us to resume our normal lives.

There are a lot of lessons to be learned from the pandemic, but no shortage of debate over what those lessons are. Witness the continuing bitter argument over how the pandemic got started. 

During the pandemic’s first year, any suggestion that an accident in a Wuhan, China, lab might be responsible was taboo among most scientists and journalists. That made serious scientific discussion nearly impossible. More recently, the debate has spilled onto a more level playing field as Congress investigates the matter. The insistence by some scientists that a zoonotic spillover in a Wuhan market is the only possible explanation continues to be eroded by new studies and new facts. While some have argued that we should do the same things no matter how the virus first infected humans, it’s harder to argue for stronger policy measures — such as regulation of risky gain-of-function research, or new restrictions on the animal wildlife trade — without the necessary facts.

One fact, which has caused a lot of reaction this past week, is that that National Institutes of Health has restored funding to EcoHealth Alliance, the New York-based “nonprofit” that subcontracted gain-of-function research to the Wuhan Institute of Virology, and which many scientists and others think might be at least partly responsible for originating the pandemic (I put “nonprofit” in quotation marks because EcoHealth and its president, Peter Daszak, sit at the top of a research empire involving tens of millions of dollars.)

Amazingly, however, there are no signs that EcoHealth Alliance—nor USAID, which spent as much as $200 million in recent years for its PREDICT program designed to predict and prevent pandemics—has engaged in any meaningful analysis or evaluation of why this incredible amount of money failed to stop the pandemic we are currently experiencing. That is a remarkable failure, on all fronts.

The pandemic has caused devastation everywhere, in rich and poor nations alike. But the developing world was particularly hard-hit and continues to be. The little bit of good news is that many poor countries, especially in Africa, mounted the infrastructure necessary to vaccinate and treat at least a portion of their populations, especially those that had strong partnerships with more developed countries and international agencies. But the weak point was access to vaccines and antiviral drugs, a problem greatly exacerbated by the strict control drug companies exercised over the distribution of lifesaving products. Nevertheless, there is now considerable evidence that granting the corporate world concessions over intellectual property was not key to getting vaccines and other drugs on the market, either in the West or the developing world.

In an eye-opening commentary in the journal Nature Biotechnology in October, E. Richard Gold, an intellectual property expert at McGill University in Montreal, argued that the Covid-19 pandemic dispelled two destructive myths about the importance of patent protection during a pandemic. 

The first is the notion that without patent protections, no vaccines or drugs would have been developed in the first place. The second is the idea that intellectual property barriers do not hinder the global distribution of lifesaving vaccines and treatments. 

Both are false, Gold argues, and he backs up his assertions with a litany of evidence. 

For example, he points out that the mRNA technology behind the vaccines developed by Pfizer and Moderna “dates back many decades and was almost entirely publicly funded.” The drug companies made most of their money on procurement contracts and licensing new technologies to deliver mRNA vaccines effectively, such as the lipid nanoparticle delivery system.

As Gold outlines, Pfizer, Moderna and their partners were able to use these more specialized patents to prevent WHO and other agencies and countries from developing their own delivery systems, sometimes bottling up vaccine and drug distribution to those countries most in need of them. 

“Rather than rely on … patents and trade secrets … to supply us with antivirals after a pandemic hits,” Gold said, “together governments, researchers and companies can develop drugs in advance. We already know the viruses that will likely cause the next pandemic.”

Is avian flu the next human pandemic?

One of those viruses, the highly pathogenic H5N1 variant of avian flu, has been rapidly spilling into mammalian populations over the past year and a half, raising alarms among experts. Have we learned the lessons that would help get us ready for it? Based on our early responses to this threat, it’s not clear that we have.

A new study by researchers in Maryland, published last month in the journal Conservation Biology, underscores just what we might be up against. And it’s not yet clear whether the kind of coordinated response needed to fight the new threat, requiring local, state, and federal responses, is ready to go.

Roee Shpernik/ Wikimedia Commons

As recent media accounts have made clear, bird flu is no longer just for the birds, even though it has been decimating poultry flocks around the world since the latest major outbreak began in late 2021. The virus has expanded its host range to include dozens of bird species it only rarely infected before. The virus has jumped to a growing number of mammalian species, including bears, bobcats, coyotes, dolphins, seals, raccoons, skunks, foxes, opossums, and minks — in other words, species to which humans are often exposed.

One of the most worrying episodes, which made even the calmest scientists very alarmed, was a major outbreak of a highly pathogenic variant of bird flu — known as H5N1 — at a mink farm in Spain. Previously, mammal-to-mammal transmission of the virus was considered fairly rare. In this case, not only did the virus spread from one mink to another, but it gained a mutation that made it easier for it to do so.

As the Maryland team pointed out in its new study, this bird flu outbreak is like no other we have seen. Previous outbreaks, for example in the U.S. in 2015, were seasonal, occurring mostly in the fall and largely controllable by the culling of poultry flocks. The current epidemic, now about 18 months long, has given the very dangerous H5N1 virus — which has caused a 50 percent death rate in the small number of human cases it has caused — a greatly increased number of chances to mutate and adapt to new mammalian species, including us.

“We’ve been dealing with low pathogenic avian influenza for decades in the poultry industry, but this is different,” Jennifer Mullinax, an environmental scientist at the University of Maryland and coauthor of the new study, told the college publication MarylandToday. “This high[ly] pathogenic virus is wiping out everything in numbers that we’ve never seen before.”

While human cases remain rare, widely publicized assurances by scientists that the danger to humans is still low are not necessarily reassuring. That’s because the H5N1 variant uses a cell receptor, called a sialic acid, to enter lung and bronchial cells when it attacks birds. So far, the virus attaches to the bird version of that particular sialic acid and not the human one. But it would take only one or two mutations in the virus for it to switch to the human version — not a high barrier for a virus that is constantly replicating and changing.

That means there is lots to worry about, and we have been very lucky so far. But some scientists are worried about another possibility: that researchers studying the H5N1 virus might accidentally release it from a lab. That possible scenario caused a controversy a bit more than a decade ago when it was revealed that NIH-funded scientists at Erasmus University in The Netherlands and the University of Wisconsin in the U.S. were genetically manipulating the virus to see how it might infect our species. In the course of their experiments, they succeeded in creating a H5N1 variant that could be transmitted through the air between ferrets.

That episode led to the long-running battle over “gain-of-function” research which continues as some scientists and activists are arguing for much stricter regulations and new laws to control research with risky pathogens.

Is that kind of research with N5N1 going on now? It’s not clear. But buried in a news story about the mink outbreak in Spain, Science magazine reported a clue that it might be happening sometime soon. The journal quoted Isabella Monne, a veterinary researcher at the European Union’s Reference Laboratory for Avian Influenza in Italy: 

Monne says her team and others are now studying the properties of the mink virus and the effects of the mutations it has accumulated. Among other things, they want to study how well the virus transmits through close contact between animals. “We are planning to also do aerosol transmission studies,’ she says.

But when I contacted Monne and her colleagues in February for further details about this research, which many scientists consider to be very risky, they were not forthcoming. “Actually, there are no further updates to share than the ones previously reported. When additional data are available we will promptly contact you,” Monne wrote me in an email.

Monne and her colleagues at the laboratory have not responded to repeated requests for updates. But it seems clear that we humans should be getting ready to fight a virus that has a 50 percent death rate, even without the mutations that would make it more easily transmissible to our species. It could make COVID-19 look like a walk in the park by comparison.

Will we be ready?

Note: Some of the material in this post is adapted from two articles earlier published at Truthdig.com