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We May Be In A Pandemic-to-Endemic Transition For COVID-19

Here's what you need to know about the difference between pandemic and endemic disease, and what they both mean for COVID-19.

By Sam Walters
Sep 26, 2022 2:30 PMSep 26, 2022 2:28 PM
COVID-19 Vaccine
(Credit: PIC SNIPE/Shutterstock)


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In an interview airing on 60 Minutes, President Joe Biden announced that the pandemic is ending in the U.S. "We still have a problem with COVID," Biden said, "but the pandemic is over."

Though the comment seems somewhat contradictory, it captures the continuing struggle among specialists to determine where we stand with the current COVID-19 pandemic. In other words, scientists simply cannot agree whether the pandemic was a problem of the past or whether continuing cases indicate that the pandemic is far from over.

The crux of the problem is that — despite what we want — diseases are tricky to eliminate, and pandemics don't end decisively. They seldom culminate with a disease disappearing completely. Instead, they typically come to their close when a disease turns "endemic," transitioning into yet another stage of activity — albeit one with a steadier, more manageable rate of cases.

So what, exactly, does it mean when a pandemic disease becomes endemic, and will COVID-19 ever experience the change?

Differentiating Endemic, Epidemic and Pandemic Disease

It makes sense to begin with the basics. Scientists who study the development and the spread of diseases tend to describe ailments according to their circulation within particular populations. And, according to the Centers for Disease Control and Prevention (CDC), three of the top descriptors include the terms "endemic," "epidemic" and "pandemic."

To start, scientists apply the term "endemic" when a disease maintains a permanent presence in a specific area and appears at a relatively predictable rate. Though this is not necessarily the ideal or the desired occurrence of the disease — which may be no occurrence at all — this state is what scientists consider stable and manageable. Essentially, endemic diseases are still active and still pose a threat to individual patients, but they rarely surge in surprising ways or cause significant disruptions in the day-to-day activities of a community.

This is all true of two familiar endemic illnesses, the common cold and the seasonal influenza, which circulate according to predictable patterns and tend not to create medical crises in the U.S.

Alternatively, specialists use the terms "epidemic" and "pandemic" after sharp and sudden increases in a disease above what scientists would normally anticipate. While "epidemics" afflict a specific area, such as single state or country, "pandemics" are much more widespread, stretching across populations and affecting several countries or continents all at once.

The widespread impacts of COVID-19 have sustained the virus's pandemic status since March 2020, but that does not mean that COVID-19 will remain a pandemic forever. In fact, viruses can cycle from state to state thanks to circumstances like the appearance of new variants or the development of new vaccines. So, even if some illnesses can't be eradicated entirely, they can shift from the pandemic stage to the endemic stage with the proper treatment.

The trick, scientists say, is increasing immunity on a broad scale. This stabilizes the occurrence of a disease, pushing it toward endemic status. In the case of COVID-19, increasing exposure to the virus via variants like omicron and increasing use of vaccines mean that more and more people are acquiring some amount of immunity to COVID-19 in the U.S. With this immunity swelling, scientists predict that the virus will spread in increasingly steady ways.

When Will COVID-19 Become Endemic?

So when, exactly, does a disease become endemic, and will COVID-19 ever secure that status? Because what scientists see as "stable" differs depending on the disease and the population that it afflicts, endemicity is best determined in the aftermath, once stabilization has already occurred. Put simply, there’s no clear scientific consensus for determining whether or not COVID-19 is currently endemic.

As such, some scientists assert that the virus already lost its pandemic label. In an interview from April, for instance, Biden's Chief Medical Advisor Anthony Fauci said that the U.S. was already transitioning "out of the pandemic phase." Yet, others say the transformation will take a little longer, with a paper from July stating that the median time for the shift to occur sits at 1,437 days after the start of the pandemic, which remains more than a year away.

Though it's probably still too soon to tell, what matters most is the fact that the majority of experts think that COVID-19 will swap its pandemic status for endemic status eventually, becoming easier to prevent and to treat as a result of the trade.

In fact, many specialists share relatively similar ideas about what COVID-19 endemicity will look like. Once the virus takes on endemic status, they say it will likely act like other common endemic conditions, transforming into a perennial or seasonal illness that’s much more of an inconvenience or an annoyance than an actual danger for the vast majority of sufferers. "People will still get infected," Fauci said in an interview last November. "People might still get hospitalized, but the level would be so low that we [wouldn't] think about it all the time, and it [wouldn't] influence what we do."

Of course, continued caution will be necessary to prevent another COVID-19 pandemic from flaring up, and vaccines and vaccine boosters will remain of the utmost importance. But, while the virus won't be disappearing any time soon, the bottom line is that the disease will likely transition to a steadier, less disruptive state — that is, if it hasn’t transitioned already.

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