We’re now entering year three of the pandemic, and it’s fair to say we’re all getting pretty sick of it, to be honest. That’s understandable – even those of us who haven’t had to cope with the disease itself have still had to live through months of various lockdowns and curfews, and there’s only so many times you can remind yourself it’s for the greater good before you start thinking “yes, but I want to go see my friends!”
If that sounds familiar, you may be excited by the recent emergence of a new watchword: endemic. That’s right – if some governments and commenters are to be believed, the pandemic is practically over. Instead, we’re heading for a new era: the era of endemic COVID.
But what does this mean, exactly? Is COVID not a problem anymore? Or is this all just wishful thinking?
whAT DOES ENDEMIC MEAN?
It’s easy to forget these days, hearing them thrown about so often by armchair epidemiologists, but both “endemic” and “pandemic” are scientifically defined terms – and if we want to understand what’s going on, we’re going to have to know the difference.
Let’s start with the one we’re familiar with: pandemic. The World Health Organization (WHO) declares a disease a pandemic when its spread is worldwide and exponential – out of control and increasing. Basically, just as an epidemic is a surge of cases in one area, a pandemic is a surge of cases everywhere.
An endemic, on the other hand, doesn’t have that surge. It may well be everywhere, like the common cold – though sometimes diseases can be endemic to one region, like malaria – but case numbers are generally just bubbling along at the same rate. It’s predictable.
So that’s the first point to be aware of: when people talk about COVID-19 becoming endemic, what they’re saying is that they foresee, for whatever reason, case numbers stabilizing.
But here’s the question: is that actually happening?
Is COVID-19 endemic yet?
If “endemic” refers to a disease with a stable rate of infections, it’s hard to see how COVID fits the bill right now.
“The idea that we will achieve endemicity anytime soon … seems a little bit counter to the fact that we’ve just had several weeks of massively explosive exponential growth,” associate professor of virology Stephen Griffin told The Guardian. “[A]nd prior to that, we were still seeing exponential growth of Delta.”
It’s a fair point. The US saw its highest number of COVID-19 hospitalizations ever last week, and healthcare systems across the world are struggling to keep up with the recent surge in cases caused by the hyper-transmissible Omicron variant.
“In terms of endemicity, we’re still a way off,” Dr Catherine Smallwood, WHO Europe’s senior emergency officer, told a press briefing on January 11.
“Endemicity assumes that, first of all, there’s stable circulation of the virus at predictable levels, and potentially known and predictable waves of epidemic transmission,” she said. “We really need to hold back on behaving as if it’s endemic before… the virus itself is behaving as if it’s endemic.”
“I don’t think we’re actually anywhere near endemic,” Lawrence Young from the University of Warwick, UK, told New Scientist. “I think a lot of it is wishful thinking.”
And just as important as understanding what endemicity is is understanding what it isn’t. It isn’t, for example, a comment on severity – as Griffin told The Guardian: “Smallpox was endemic, polio is endemic, Lassa fever is endemic, and malaria is endemic … Endemic does not mean that something loses its teeth at all.”
And it doesn’t mean it’s gone away, either. OC43, one of the coronaviruses that can cause the common cold, is endemic, the New Scientist points out, and that affects around 45,000 people every day in the UK alone.
WilL COVID become endemic?
So will COVID become endemic? Perhaps – but we can’t know yet when or even if it will happen. The transition into endemicity is often only seen in retrospect, and at the moment, as Dr Smallwood said, we’re “still a way off”.
Many experts agree it's too soon to label the virus as endemic when it's still spreading and potentially evolving – particularly in large parts of the unvaccinated world. As the WHO has often pointed out, "vaccine equity will accelerate the end of the pandemic." Vaccine inequity will prolong it.
“What we’re seeing at the moment, coming into 2022, is nowhere near [endemicity] … we can't just sit back and see a stable rate of transmission,” Dr Smallwood said.
“We still have a huge amount of uncertainty, we still have a virus that’s evolving quite quickly and posing quite new challenges … It may become endemic in due course, but pinning that down to 2022 is a little bit difficult at this stage.”