Well-Being Prevention & Cures

We need to define when a pandemic becomes endemic

Story at a glance

  • An endemic disease is one that becomes stabilized within a population.
  • Outbreaks may still occur.
  • The coronavirus causing the COVID-19 pandemic could be on its way to becoming endemic, but we don’t know enough yet and it’s difficult to predict.

Governors and public health officials are split over whether the COVID-19 pandemic is reaching the endemic phase nearly two years after much of the nation was first locked down. Others say there is debate over the very definition of endemic, especially as it is applied to the coronavirus. 

The United States is emerging from an omicron surge that led to record-high cases, a development that some hoped could push the country toward an endemic phase where masks and other restrictions could be lifted as the nation learned to live with the coronavirus — much like it lives with the flu. 

But whether that stage is on the horizon is hotly disputed. And even if the nation is inching toward an endemic and away from a pandemic, some warn the country must still be ready for difficult days ahead. 

Governors dealing with voters who are sick and tired of both the pandemic and related restrictions are increasingly saying it’s time to call it an endemic. 

“I do believe that we need to move from a pandemic status and mode of operation, to more endemic, where we’re normalizing, taking it very seriously, preparing, but I think we need to move out of the panic mode,” Arkansas Gov. Asa Hutchison (R) said late last month during an appearance on NBC’s “Meet the Press.” 

Gov. Phil Murphy (D) of New Jersey, in announcing preparations to end his state’s mask mandate in schools, said, “we have to learn how to live with COVID as we move from a pandemic to an endemic phase of this virus,” according to a media briefing on Feb. 7. 

“I think many of them are not clear what they mean when they use the term,” Tara C. Smith, a professor at the College of Public Health at Kent State University, said in an email to Changing America. “’Endemic’ just means that it is not going away. It doesn’t mean mild or harmless, or even a low level of transmission. Yet it’s being used to mean all of those things by some people.” 

Recently, Wisconsin’s top medical officer said that the coronavirus could become endemic in 2022, according to The Associated Press. The state’s cases have come down from an omicron peak of a seven-day average of nearly 19,000 for daily cases to below 5,000. If cases stay low, that could potentially signal stabilization of the coronavirus. 

A health official in Vancouver also stated that they were moving more toward an “endemic” approach to handling COVID-19. Colorado recently announced a shift to an endemic response could happen as early as this summer. Others, such as the top Ohio health official, are refraining from saying as much, stating that “we are on the way there” although we are not there yet. 

When asked if it seems we are on the way to the coronavirus becoming endemic, Smith said “I suspect so, but I don’t think we’re there yet.” She continues, “And even if we are, we still are suffering from thousands of deaths per day, an under-vaccinated population, and the threat of new variants ever-present that could send us into new surges.” 

A disease becoming endemic is typically a transitional process that takes place over long periods of time. There are several factors that go into a pathogen becoming endemic, including the susceptibility of a population, behavior changes that affect transmission and whether the pathogen itself is changing. “The same virus can cause endemic, epidemic or pandemic infections: it depends on the interplay of a population’s behaviour, demographic structure, susceptibility and immunity, plus whether viral variants emerge,” writes evolutionary virologist Aris Katzourakis in a piece published in Nature. “Different conditions across the world can allow more-successful variants to evolve, and these can seed new waves of epidemics.” 


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Epidemiologists and health officials may not always agree on what endemic means. Generally, a disease that is endemic has a predictable pattern of cases, whether that means it has reliable seasonality or a stable geographic distribution, said epidemiologist Delivette Castor at the Department of Medicine at Columbia University. We have to decide what is a tolerable level of cases to call it an endemic disease, Castor adds. 

But seeing that omicron only recently bled into the U.S., it may be too soon to predict what could happen in 2022, experts warn.  

A new variant could emerge and lead to new surges, and that could cause whiplash if states are already thinking of the coronavirus as endemic. Health officials around the world are keeping an eye on an omicron subvariant named BA.2, which has overtaken the original omicron variant in some countries in Europe like Denmark. Because the virus is still widespread, there is still the possibility that more variants could emerge within and outside of the U.S., leading to a prolonging of the emergency situation. 

Even if the coronavirus becomes endemic, there could be a high case rate and subsequent hospitalizations and deaths. Outbreaks do happen with endemic diseases since there can be variability in disease prevalence, even for diseases that are considered endemic. For example, malaria is endemic in many parts of the world, but how present it is in the population can depend on the seasons, the geographical location, the mosquito species that act as vectors, as well as many other factors.

It may be helpful to begin thinking about a strategy for endemic coronavirus, though we may not be able to predict what that would look like and when it could happen. Castor also thinks that we aren’t at the endemic stage yet, but it looks like we are on the way there. If we decide on a certain threshold level of cases each year or by season, what that means exactly and what that cycle looks like is still unclear, said Castor. How endemicity is defined may also vary by region.

“I think right now we’re at a feeling,” she continues. “We’re feeling like it’s gonna be endemic. We’re using the term endemic as a way to say we’re gonna live with this and try to behave in a ‘normal’ way. But there’s a lot of quantification that needs to happen in order for us to predict so that we can respond.” 


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