As the world marks five years since the emergence of COVID-19, the World Health Organization (WHO) has released a special epidemiological update reflecting on the global trajectory of the pandemic. From its first reported cases to its current status, the report sheds light on the virus’s continuing impact, the challenges of monitoring its spread, and the progress made in mitigation efforts.

COVID-19, caused by the SARS-CoV-2 virus, has defied the seasonal patterns typical of many respiratory illnesses, circulating year-round and causing severe acute disease and long-term conditions such as post-COVID-19 condition (PCC), commonly referred to as "long COVID." Despite significant strides in understanding and managing the virus, the global response is hindered by reduced surveillance, testing, and genome sequencing. WHO’s ability to track the virus’s evolution and severity remains uneven, with efforts to integrate COVID-19 into long-term prevention strategies varying widely across regions.

Since the start of the pandemic, over 776.8 million confirmed cases and 7 million deaths have been reported across 234 countries. The most devastating impact was seen during the early years of the pandemic—2020, 2021, and 2022—before increased immunity from vaccination and prior infections led to a significant decline in fatalities. In the latest four-week reporting period, from October 14 to November 10, 2024, 77 countries reported over 200,000 new COVID-19 cases and 27 deaths globally, reflecting a 39% decrease in cases and a 36% decline in deaths compared to the preceding month.

Hospitalization trends have mirrored these declines. Intensive care unit (ICU) admissions, which peaked in mid-2021 at 245 per 1,000 hospitalizations, steadily decreased to less than 69 per 1,000 by the end of 2023. Although there was a brief surge in early 2024, ICU admissions stabilized at 108 per 1,000 hospitalizations by November 2024. Similarly, deaths per 1,000 hospitalizations dropped from 253 in June 2021 to just 41 in November 2024, underscoring the significant progress in managing severe cases.

However, the ongoing burden of post-COVID-19 condition remains a critical challenge. WHO estimates that approximately 6% of symptomatic infections result in PCC symptoms, with most cases arising after mild infections due to the sheer number of infections globally. Vaccination has emerged as a protective factor, reducing the risk of developing PCC and highlighting the importance of immunization in mitigating long-term health effects.

The global rollout of COVID-19 vaccines, which began in 2021, has undergone significant evolution. While high-income countries initially led in vaccination coverage, WHO has since shifted its focus to annual vaccine uptake. By the end of the third quarter of 2024, 39.2 million people in 90 Member States had received at least one dose this year, with 14.8 million doses administered in the third quarter alone.

Despite the progress, WHO emphasizes the need for sustained vigilance. The virus continues to evolve, and integrating COVID-19 measures into broader health frameworks remains critical to ensuring global preparedness for future challenges. This special edition of the epidemiological update offers a comprehensive reflection on the pandemic’s trajectory, underscoring the lessons learned and the work that lies ahead in combating the enduring impact of COVID-19.