As we head into the third year of dealing with COVID-19, experts seem to agree that the virus that has been dominating our lives isn’t going away any time soon. But that doesn’t mean that we will be living through a pandemic forever. The hope is that advances like COVID-19 vaccines and new treatment options will help us move into a new state, an endemic state. But what is the difference between these two states of disease spread and what does this change mean for our lives?
Many experts say that COVID will likely lose its “pandemic” status sometime in 2022, due largely to rising global vaccination rates the widespread, less lethal, infection with the Omicron variant. “If the virus does become more seasonal, wearing a mask on public transit and indoors during COVID season could become the new normal and other familiar prevention strategies, like regularly washing your hands and maintaining distancing practices in high-risk settings, could also stick around during seasonal spikes,” said Dr. Albert Rizzo, Chief Medical Officer of the American Lung Association.
Epidemic vs Pandemic
An outbreak is a sudden rise in the number of cases of a disease more than normal expectancy in a community or geographical area. An outbreak can be declared an epidemic when the disease spreads rapidly to many people.
In December of 2019, the news was full of reports of an epidemic in Wuhan, China. Similar to an outbreak, an epidemic is defined by being contained in a small population, but the number of cases is larger than normally expected. Other examples of epidemics in our modern world include yellow fever, smallpox, and West Nile. Epidemics can also describe things that aren’t contagious like teen vaping or obesity.
Many epidemics can be contained and do not spread worldwide. But this was not the case for SARS-CoV-2, a virus which quickly became more widespread, with cases present worldwide. The number of people affected was exponentially growing and the World Health Organization (WHO) upgraded COVID-19 to a pandemic in March 2020.
Pandemics are known to cause large-scale social disruption, economic loss, and general hardship, and COVID-19 has been no exception. Early on, people found themselves quarantined in their homes for long periods of time, isolated from friends and loved ones until experts could find a way to control the spread of the infection.
Pandemic vs Endemic
The availability of the COVID-19 vaccine was a key step toward ending the pandemic or transitioning into an endemic. Enough people need to have immune protection from the virus for it to become endemic, highlighting the importance of vaccination. Though an endemic is a constant presence in a community, it differs from a pandemic because the virus is somewhat contained and not spreading out of control and not stressing the health care infrastructure, therefore we can more easily prevent and treat it. For example, the flu is a common endemic virus for which there are treatment options and a yearly vaccine. However, there can be outbreaks of flu that can lead to an epidemic, with the potential to occasionally become a pandemic as was seen with the H1N1 flu pandemic of 2009.
So, though SARS-CoV-2 may never go away, experts want to understand it so that we can return to our normal ways of living. By creating a vaccine and finding effective treatment options, the goal is for COVID-19 to be less deadly and destructive. Mutating variants of the COVID-19 virus have unfortunately delayed this transition. There are many who believe Omicron is the final wave of the pandemic. That thought is based on the feeling that there will be so much immunity in many populations due to the overwhelmingly easy spread of the Omicron variant that transmission rates will drop, and SARS-2 will transition into something more akin to the influenza-like illnesses that sicken people during the winter months but are far less disruptive than the pandemic has been. If transmission slows, hopefully so too will the virus’s accumulation of mutations that could avoid our treatments or immune protection.
How COVID-19 Can Become Endemic
Earlier in the pandemic, many experts agreed that the goal was to reach herd immunity, which is when enough of the population has been vaccinated or recovered from the infection that a resistance is built up, thus slowing the spread of the virus. However, now that we better understand how the virus mutates and spreads, and immunity wanes over time, eradication has proven unlikely.
But according to Dr. Fauci, that is not the goal. He told Reuters in November, “To me, you want to get to endemic (…) People will still get infected. People might still get hospitalized, but the level would be so low that we don't think about it all the time and it doesn't influence what we do."
A key step is getting as much of the population to receive the recommended COVID-19 vaccine and boosters as possible. The availability of new treatment options, such as monoclonal antibody or antiviral treatments, are also poised to move us in the right direction. Until then, keeping masks on and maintaining social distance and hygiene practices is the best way to help us one day move into this new endemic state.
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Blog last updated: January 17, 2023