March 17, 2023 – Three years have passed because the World Health Organization officially declared The COVID-19 emergency is a pandemic. Now that health systems are not any longer overwhelmed and there have been no surprise variants for over a 12 months, many infectious disease experts are moving from a pandemic to an endemic crisis.
Endemic broadly signifies that the virus and its spread in certain regions are predictable and stable. But not all experts agree that that is the case yet.
Eric Topol, MD, founder and director of the Scripps Research Translational Institute in La Jolla, California, and editor in chief of Medscape, WebMD's sister site for healthcare professionals, said it's time to call COVID endemic.
He wrote in his Substack: Basic truththat each one information – from genomic surveillance of the virus To sewage to clinical Results still being tracked – point to a brand new reality: “[W]We have (finally) entered an endemic phase.”
So far, no recent SARS-CoV-2 variants have emerged which have a growth advantage over XBB.1.5. dominant in much of the worldor XBB.1.9.1, wrote Topol.
But he has two concerns. Firstly, the variety of every day hospital admissions and deaths, which in response to The New York Times COVID TrackerThat's way over the every day variety of deaths during a severe flu season.
“That’s much more (than double) than in June 2021,” he wrote.
Topol's second concern is the chance that a brand new family of viruses could emerge that's much more contagious or deadly – or each – than the recent omicron variants.
Three reasons to call it endemic
William Schaffner, MD, an infectious disease expert at Vanderbilt University Medical Center in Nashville, also falls into the endemic camp for 3 reasons.
First, he said, “The immunity in the population is very high. We are no longer seeing large outbreaks, but we are seeing ongoing smoldering transmission.”
While Schaffner pointed to the worrying variety of every day deaths and hospitalizations, he said that “it no longer causes a health care crisis, nor does it cause any broader economic and social impact on the community.”
“Third, the variants that cause disease are Omicron and its descendants, the Omicron subvariants. And whether because of population immunity or because they are inherently less virulent, they cause milder disease,” Schaffner said.
Changing social norms are also an indication that the United States is making progress, he said. “Look around. People are behaving endemicly.”
They are removing their masks, gathering in crowded spaces and refusing additional vaccines, “which implies a certain tolerance to this infection. We tolerate the flu,” he noted.
Schaffner said he would limit his focus to the areas where COVID is endemic or near-endemic, namely the developed countries.
“I am more cautious about developing countries because our surveillance system is not as good there,” he said.
He added a caveat to his enthusiasm for the endemic status, acknowledging that a highly virulent recent variant that may resist current vaccines could torpedo the endemic status.
No big peaks
“I would say we are endemic,” said Dennis Cunningham, MD, medical director of infection prevention at Henry Ford Health System in Detroit.
“The definition I use is that we know there is a disease in the population. It occurs regularly and at a consistent rate. In Michigan, we no longer have these huge numbers of cases,” he said.
Cunningham said that while the variety of deaths from COVID is concerning, “I would say cardiovascular disease is endemic in this country, and we have well over a few hundred deaths every day because of it.”
He also identified that vaccinations have largely controlled the disease, leading to a discount in hospitalizations and deaths.
The discussion is definitely becoming an educational dispute, said Cunningham.
“Even though we call it endemic, it is still a serious virus that puts a heavy burden on our health system.”
Not so fast
But not everyone seems to be ready to completely commit to “Endemie”.
Stuart Ray, a professor of drugs within the division of infectious diseases on the Johns Hopkins School of Medicine in Baltimore, said any classification as endemic can be limited to a particular area.
“We don't have much information about what's happening in China, so I don't know if we can say, for example, what state they're in,” he said.
In the US, too, information is incomplete, Ray said, noting that while home testing within the US is a fantastic tool, it makes determining the actual variety of cases difficult.
“Our visibility into infection numbers in the United States has understandably been compromised by home testing. We need to use other means to find out what is happening with COVID,” he said.
“There are people with infections that we don't know about, and this dynamic could surprise us,” he said.
In addition, there are increasing numbers of young individuals who haven't yet had COVID, and given the low vaccination rates amongst young people, “we could see a sharp increase in infections again,” Ray said.
Why no official declaration of endemic disease?
Some wonder why neither the WHO nor the CDC have declared the disease endemic.
According to Ray, health authorities were earlier in declaring a state of emergency, but were slower to declare the top of the emergency, in the event that they did declare one in any respect.
President Joe Biden has May eleventh as end the COVID emergency declaration within the United States after the deadline had been prolonged several times. The emergency status allowed thousands and thousands of individuals to receive free tests, vaccines, and coverings.
Ray said that only in hindsight will we actually know when the epidemic began.
“Just like we'll look back on March 9 and say winter is over in Baltimore. But there could be a storm that will surprise me,” he said.
Not enough time to know
Epidemiologist Katelyn Jetelina, PhD, MPH, director of population health analyses on the Meadows Mental Health Policy Institute in Dallas and senior science adviser to the CDC, said we haven't spent enough time with COVID to call it endemic.
With endemic flu, she said, “everything is predictable and we know when there will be waves.”
But with COVID, there are too many unknowns, she said.
What we do know is that the transition to endemic doesn't mean the top of suffering, said Jetelina, who also runs a substack called Your local epidemiologist.
“We see this with malaria and [tuberculosis] and flu. There can be suffering,” she said.
Public expectations regarding the tolerance of COVID-related illness and death are still widely debated.
“We don't have a metric for what constitutes a suitable risk of death in an endemic. It's more defined by our culture and our values and what we ultimately accept,” she said. “So we're experiencing this tug-of-war between urgency and normality. We're deciding where to put SARS-CoV-2 in our threat repertoire.”
She said in the U.S., people don't know what these waves will look like – whether they will be seasonal, whether there will be another summer wave in the South, or whether a new variant of concern will emerge out of nowhere.
“I can imagine a future where (COVID) will not be an enormous problem in certain countries where there may be such high immunity through vaccination, while somewhere else it continues to be a crisis.
“We all hope that we are slowly approaching the endemic phase, but who knows? SARS-CoV-2 has taught me to approach it with humility,” said Jetelina. “Ultimately, we don't know what will happen.”