How does COVID define endemic?

The coronavirus started as an epidemic and then became a pandemic. Now, we hear it over and over that it is on the verge of becoming an endemic. That means COVID will forever be part of our lives in some form, like how the Spanish flu of 1918 morphed over time into the common flus of today.

As we grapple with Delta rage, it’s helpful to understand what endemic means when it comes to COVID both in terms of what we do in the present and what our day-to-day will look like in the future. Public health experts say that even though COVID may eventually be endemic it does not mean that we need to stop trying to control the disease. Even if we get more people vaccinated, it’s possible to experience some discomfort for a few days, then the symptoms will disappear, until you do it again next year.

Jennie Lavine, Emory University researcher, told The Atlantic that there will come a day when everything is the same as it was in two years. Although that’s the direction we are heading, we still have a long way to go.

What is endemic?

An epidemic is a sudden spike in the number of cases of a particular disease. Pandemics are when the disease is spread uncontrollably to multiple countries. It’s an endemic disease when it grows so deeply that it hums at predictable, controlled levels.

COVID is “too widespread” now to be eradicated from people, Dr. Rachel L. Roper of East Carolina University’s medical schools wrote via email. She has a doctorate degree in microbiology as well as immunology.

Malaria and dengue are widely thought of as endemic in parts of Africa. The chickenpox is endemic worldwide. Respiratory syncytial virus, also known as RSV, is also endemic in the U.S. According to the Mayo Clinic, it can cause pneumonia in babies and adults, although it looks similar to the common cold.

With an epidemic, the risks are generally unclear at first, Harvard Immunologist Yonatan Grad told the university’s communications team in a Q&A. COVID, even if it became endemic would still be present, but the spread of it would slow down and there’d be systems to stop it from pounding us with more constant, relentless waves. We need to have more immunity, and less transmission in order to achieve that situation. While vaccinations and infected can increase immunity, there are many things we need to know about the duration and how high it is.

Grad stated that viruses can spread to any place there is enough people who are susceptible and sufficient contact between them for spread to continue spreading. Grad said it was difficult to predict the timeframe to see COVID-19 becoming an endemic disease. It depends on the duration and strength of immunity from natural infection and vaccination, as well as our contact patterns that permit spread and transmission of the virus.

What will it take to make COVID endemic?

Numerous virologists think we are on the verge of COVID becoming an endemic. However, it is not clear when we will flip the switch to dealing with an epidemic virus to one that has become endemic.

“It really is more of a process where we understand that there’s not going to be uncontrolled community-based spread and that by allocating to COVID-19 the resources that we normally allocate to other endemic conditions [and] are sufficient to keep the infection under control,” Dr. Brian Conway, medical director of Vancouver Infectious Diseases Centre, said, according to Canadian broadcaster Global News.

The science journal Nature surveyed 119 infectious disease researchers and immunologists to determine if COVID would be an endemic. Michael Osterholm from the University of Minnesota, Minneapolis said Nature that eradicating COVID now is like planning the construction of the stepping-stone path to the Moon. This is impossible.

It is possible for COVID to decrease in certain parts of the globe but remain stubbornly high elsewhere. This depends on how local health protocols are implemented. Nature says that the greater the vaccination coverage in an area, the higher chance of immunity. For example, the measles have been eradicated from the U.S. as an endemic disease since 2000, but cases flares up now and then due to international travelers (and anti-vaccination misinformation). Remember the Disneyland measles outbreak from 2015?

A disease can rarely disappear completely. According to the World Health Organization (WHO), two examples of diseases that were eradicated are smallpox, rinderpest and cattle plague. Both were eradicated by vaccinations.

Roper stated that SARS was stopped by quarantine and isolation in 2003. Roughly 8,000 people were infected in 29 countries at the time, according to the CDC.

Why hasn’t COVID become endemic despite the availability of vaccines?

In some cases, higher vaccination rates might be enough to stop COVID. However, this depends on the number of people who get vaccines and their effectiveness in reducing transmission.

Public health officials continue to insist that vaccines do what was expected: they prevent hospitalizations and deaths. However, not enough people are vaccinated. Although we wish that a single drop of vaccine would magically cure COVID, pharmaceutical companies don’t have the power to make it go away.

It will spread as long there are still people not vaccinated.

COVID will “hopefully become quite rare in the U.S., where effective vaccines are widely available. It will spread as long as people don’t get vaccinated. Roper said that the spread of it is dependent on how many people are not vaccinated.

According to KFF data, which is a non-profit health research organization, COVID can be more common if you aren’t vaccinated.

Globally, the number of people who are not vaccinated is high due to a range of factors, including distrust and political schisms in the U.S., vaccination hoarding in rich countries, restricted access in poorer nations, logistical problems with some being unable to work, or to get childcare, when they get jabbed, and temporary flu-like side effect.

Only 23 percent of the world’s population is fully vaccinated against COVID and 31 percent are partially vaccinated, according to Our World in Data, an online educational resource focused on global living conditions.

Does possible endemicity imply that we should stop trying?

According to The Atlantic, vaccinating, wearing masks and social distancing can reduce hospital overcrowding and help keep schools and restaurants open. If you have disposable income, you can donate to help people around the world get vaccinated too. The situation will dictate how often or far apart we need to stand from one another. According to the CDC, it depends on what situation we are in. You may not need to wear a mask if you are walking your dog outdoors. Two vaccinated individuals can stand together and speak without masks. Healthcare officials warn that the risks increase when they chat in an enclosed space with strangers, whose vaccination status may be different.

“Even in situations where you have high vaccine coverage, if you’ve got a lot of transmissions then you wouldn’t take your mask off,” Dr. Michael Ryan, a WHO executive said at a press conference earlier this summer.

COVID might become an endemic disease, but that doesn’t mean it is time to stop fighting.

Dr. Arrianna planey is a doctoral geographer who has a PhD in geography and geographical information science. She tweeted that “endemicity does not mean destiny.”

UPDATE: August 15, 2021 at 5:25 PM PDTThis article has been updated with comments by Dr. Rachel L. Roper (a professor of microbiology at East Carolina University’s Medical School) and information regarding RSV.

Publiated at Sun, 15 August 2021 23.16:42 +0000

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