Borders are open. Hospitals are operating, in most jurisdictions, at near-normal capacity. The phrase 'living with the virus' has migrated from political slogan to settled assumption. And yet the disease itself has not gone anywhere.

Public health authorities in most developed countries have stopped publishing daily case counts. The World Health Organisation declared the global health emergency over in 2023. By any of the criteria that defined the emergency phase, the pandemic is, structurally, over.

What that means in practice

It means that COVID-19 is now treated as one of several seasonal respiratory viruses, alongside influenza and respiratory syncytial virus. Hospitalisation rates rise in winter and fall in summer. Vaccinations are recommended for older adults and those with significant comorbidities, but no longer mandated for the general population.

It does not mean the disease has been eradicated, or that its long-term effects on the populations that survived it are well understood. Long COVID, in particular, remains a significant clinical research priority in most major economies.

What we still don't know

Five years on, the open questions remain considerable. The mechanisms behind long COVID are not fully understood. The relative contributions of vaccination, prior infection and antiviral medications to the eventual decline in mortality are debated by epidemiologists.

"The emergency phase ends when society agrees it has ended. The clinical phase ends much later."

A test we will probably face again

Most public-health officials, in private, accept that the world will face another respiratory pandemic in their working lifetimes. The question is whether the institutions that responded to COVID-19 — global, national, local — will respond to the next one with the same speed, or with the calibrated weariness of an institution that has already paid for a long emergency.

Either answer is plausible. Neither is reassuring.