The WHO announced COVID-19 is no longer a global public health emergency amid the spreading of arcturus variant: a correspondence evaluating this decision

Dear Editor,

After an outbreak in Wuhan, China, in December 2019 of a disease similar to pneumonia but unresponsive to treatment, the WHO declared on 11 March 2020, this disease as coronavirus disease 2019 (COVID-19) a worldwide pandemic¹. This ribonucleic acid virus, which arose from the Severe acute respiratory syndrome coronavirus 2 virus, is known to spread from human-to-human through inhaling infected air. It results in symptoms of fever, cough, and fatigue, which are so severe that many cases have required hospitalization². To help control the situation vaccines and antiviral drugs were quickly developed. The US Food and Drug Administration officially approved the Pfizer-BioNTech vaccine on 23 August 2021³. Soon after, however, in November of 2021, a variant known as omicron was declared and rapidly spreading⁴. As of 10 May 2023, there have been over 765 million cases with nearly 7 million deaths, and more than 13 billion vaccine doses have been administered⁵. The WHO recently issued a new statement on 5 May 2023, declaring that COVID-19 is no longer a pandemic-level threat⁶, and this decision has created some skepticism.

The WHO finalized this decision after discussing in their meeting that there has been a decrease in deaths, hospitalizations, and admission into the intensive care unit due to COVID-19. They have acknowledged that it still circulates; however, they claim that it is not alarmingly unusual anymore. Ultimately, they believe that with their new ‘2023–2025 COVID-19 Strategic Preparedness and Response Plan’, a continued push for vaccinations, and continued monitoring and reporting of the virus, we can move away from calling this virus a pandemic⁶. This is surely a great thing and much regard should be given to the healthcare professionals who have allowed us to better control this virus. However, this decision is being made too soon. Let us not forget how the virus erupted in the first place: human-to-human contact. Furthermore, while it has a lower fatality rate of 4% compared to the fatality rate of 10% for SARS, it is far more likely to spread as people can transmit the virus unknowingly⁷. Also, concerning is the number of variants, with omicron (B.1.1.529 lineage) being the most dominant, as well as others including alpha (B.1.1.7), beta (B1.351 lineage), gamma (P.1 lineage), delta (B.1.617.2 lineage)⁸. With the summer months fast approaching, it can be assumed that this declaration by the WHO will result in more people traveling and gathering together. With a death occurring every 3 min throughout the world and 158 deaths per day in the United States⁹, this decision could make this number rise significantly.

We must also take into consideration the long-term COVID-19 effects when evaluating the recent decision made by the WHO. These effects fall into the diagnosis of post-COVID-19 syndrome according to the Mayo Clinic. Full recovery from this disease is not always to be expected when one becomes infected with the virus. In some cases, when their infection is so severe the virus can elicit permanent damage to organs such as the brain, liver, and heart, thus causing lingering symptoms. These symptoms include long-term fatigue, respiratory issues, neurological issues, and heart issues among many others¹⁰. There is not much known about curing these long-term COVID effects and the only treatment is to seek medical help to help one live more comfortably¹¹, therefore, it is imperative that we can handle COVID-19 cases properly to not let them get so severe that the patient will have to live with chronic symptoms. A resurgence of cases is the last thing our world needs, and it could very well put a strain on the healthcare system yet again, and lead to more and more individuals experiencing these long-term effects.

In March 2023, several variants like BA.2, BA.4, and BA.5 were deescalated from the lists of Severe acute respiratory syndrome coronavirus 2 variants of concern because their parental lineages are no longer detected. Some variants are still a concern due to the spike mutation and high spreading ability. One such variant, XBB.1.16, belongs to the omicron lineage and is currently circulating rapidly throughout India and neighboring countries¹². It has sparked a significant rise in cases in India having 49 662 confirmed COVID-19 cases as of 14 April 2023¹³. This variant mutation is made from a recombination of BA.2.10.1 and BA.2.75, and thus can increase one’s susceptibility to the virus. Twelve children’s are being affected, with common symptoms being respiratory issues, fever, and conjunctivitis. Furthermore, there is concern about this variant becoming dominant and spreading further as it is known to be more infectious compared to other mutations¹³. Along with its increased infectivity, doctors and health professionals are becoming wary and expect yet another worldwide spread. Throughout India, personal protective measures have already been reintroduced such as masking and social distancing¹⁴. The statement recently released by the WHO is shocking considering the effects that could result if COVID-19 is taken out of pandemic-level status. There is already a new strain circulating, along with various other variants of concern, variants of interest, and variants under monitoring¹⁵. The lessening of these restrictions leads to the assumption that people may begin traveling again. With the overwhelming number of variants, the probability of more recombination creating even more mutations is high. When one is infected with numerous strains at one time, the viruses can combine whilst undergoing the process of replication within the body. This, in turn, leads to the creation of a new virus that can be spread¹². We have already made great strides toward controlling this virus, and with restrictions being taken away at a time like this when there is already a concern for a resurgence with the Arcturus variant, it could allow the virus to erupt and send our world into another state of chaos. While the WHO has policies put in place to handle such resurgences under their new statement, withdrawing the restrictions is a decision that should be evaluated again.

Ethical approval

Not required for this study.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author contribution

M.A.R., S.C., and Y.S.: conceptualization, data curation, writing – original draft; M.A.B. and M.R.I.: supervision, validation, writing – review & editing. All authors reviewed and approved the final submission.

Conflicts of interest disclosure

The author(s) of this work have nothing to disclose.

Research registration unique identifying number (UIN)

1. Name of the registry: Not applicable.

2. Unique Identifying number or registration ID: Not applicable.

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Guarantor

Md. Rabiul Islam: Department of Pharmacy, University of Asia Pacific, 74/A Green Road, Farmgate, Dhaka 1205, Bangladesh.

Data availability statement

Data not available/not applicable.