Is COVID Endemic? Experts Offer Insights on the Ever-Changing Virus

Is COVID Endemic? Experts Offer Insights on the Ever-Changing Virus

We’re now in year three of the COVID-19 pandemic and it’s only natural to wonder when the constant ebb and flow of cases will finally end. While some people have held out hope that the coronavirus will just go away at some point, most public health experts agree that the virus will never really disappear—begging the question, is COVID endemic yet?

“SARS-CoV-2, the virus that causes COVID-19, is not going away,” says Thomas Russo, M.D., professor and chief of infectious disease at the University at Buffalo in New York. “There are still people who think that this virus is going to disappear—it’s not,” says William Schaffner, M.D., an infectious disease specialist and professor at the Vanderbilt University School of Medicine.

Before we delve into the science, you might be wondering what endemic means. The phrase “endemic” refers “to the constant presence and/or unusual prevalence of a disease or infectious agent in a population within a geographic area,” according to the Centers for Disease Control and Prevention (CDC). When a disease or virus is endemic, it exists at a certain level over time and tends to have fairly consistent case levels.

An endemic virus may have hot spots in certain areas of the country here and there, but the levels are largely consistent, says Dr. Russo.

What will happen at some point, experts say, is that the virus will become endemic. Anthony Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), first mentioned the possibility of COVID-19 reaching endemic status back in November 2020. “We need to plan that this is something we may need to maintain control over chronically,” he said during a webinar. “It may be something that becomes endemic, that we just have to be careful about."

Dr. Fauci again reiterated his thinking that COVID-19 will become endemic while speaking in February 2022 at the World Economic Forum's Davos Agenda. “If you look at the history of infectious diseases, we’ve only eradicated one infectious disease in man, and that's smallpox. That’s not going to happen with this virus,” he said. “But hopefully it will be at such a low level that it doesn’t disrupt our normal social, economic, and other interactions. That’s what most people feel when they talk about ... endemicity, where it is integrated into the broad range of infectious diseases that we experience.”

So…are we there yet? With the CDC adjusting quarantine times and , many people believe this means we’ve reached endemic status. But is this accurate? Here’s what you need to know.

Is COVID-19 endemic yet?

It depends on who you talk to. Dr. Russo says we’re “transitioning” from pandemic to endemic status but aren’t there yet. “Right now across the country, hospitalizations and deaths from COVID-19 are down,” he says. “There are local outbreaks in some areas and others are quiet.” The rise of the BA.2 variant has caused cases to jump again in some areas, which has slowed the transition to endemic status and caused some uncertainty about where things are headed, Dr. Russo says.

“We’re clearly moving in that direction,” Dr. Schaffner says. “The CDC and White House [do] not seem ready to declare that we’re in an endemic state. Saying, ‘the pandemic is over’ will likely be misinterpreted by people as saying, ‘We don’t have to worry about COVID anymore’ and that’s not the case.”

But infectious disease expert Amesh A. Adalja, M.D., a senior scholar at the Johns Hopkins Center for Health Security, says that COVID-19 is already endemic. “I do think that COVID-19 is endemic in the United States as it is ubiquitous and is no longer causing disease at a rate that is too much for hospitals to handle,” he says. “COVID-19 will always cause a baseline number of cases, hospitalizations, and deaths but as it gains an endemic status it will not be able to overwhelm hospitals to the degree that it once did.”

When will COVID become endemic?

It’s hard to say, especially since there usually isn’t a big announcement about this kind of thing. “There is no official designation when a disease becomes endemic,” Dr. Adalja says. Instead, “there is more of a general understanding among the public health and infectious disease community” that a disease has reached endemic status, Dr. Schaffner says.

Predictions for when COVID will become endemic get a little tricky because there is always the risk of new variants slowing or even reversing the process, Dr. Russo says. “It could go in either direction going forward,” he says. “We could continue to do well—if a new variant doesn’t arise and if people keep up with their vaccinations. Or we could go in the other direction if a new problematic variant arises that evades our immunity. This is a dynamic situation.”

As for the role vaccines play in helping end a pandemic, Dr. Russo says they definitely help. “The key in terms of getting a virus to an endemic and a manageable magnitude of disease is how much immunity we have. We need more immunity over time through vaccination and infection, including boosters as needed. That’s going to help keep the virus manageable,” he says.

It’s hard to say what will change once COVID becomes endemic, though, Dr. Schaffner says. “Will we need boosters periodically? Will we still have to, under certain circumstances, wear a mask? Will we expect some seasonality—more COVID in the winter than summer? We don’t know yet,” he says. “Just as we live with and cope with influenza, so it might be with COVID.”

Endemic vs. pandemic

Endemic is not the same as pandemic. A pandemic is an event that happens where a disease spreads across several countries and impacts a large number of people, the CDC explains.

The World Health Organization (WHO) declared COVID-19 a global pandemic in March 2020, and the designation has not officially changed since then.

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