March 17, 2023 — It has been 3 years since the World Health Organization officially declared the COVID-19 emergency a pandemic. Now, with health systems no longer overwhelmed and over a year of unsurprising variants, many infectious disease experts are declaring a crisis shift from pandemic to endemic.
Endemic, broadly defined, means that the virus and its patterns are predictable and stable in designated regions. But not all the experts agree that we are there yet.
Eric Topol, MD, founder and director of the Scripps Research Translational Institute in La Jolla, Calif., and editor of Medscape, WebMD’s sister site for healthcare professionals, said it’s time to call COVID endemic .
It wrote in its substack, Ground Truththat all indications – of virus genomic surveillance For Waste at the clinic results that are always tracked — point to a new reality: “[W]We have (finally) entered an endemic phase. “
No new variant of SARS-CoV-2 has yet emerged with a growth advantage over XBB.1.5, which is dominant in much of the worldor XBB.1.9.1, wrote Topol.
But he has two concerns. One is the number of daily hospitalizations and deaths – hovering around 26,000 and 350 respectively, according to The New York Times COVID tracker. This is far more than the daily number of deaths during a severe flu season.
“This is way beyond (double) where we were in June 2021,” he wrote.
Topol’s second concern is the possibility of a new family of viruses evolving that is even more infectious or deadly – or both – than recent Omicron variants.
Three reasons to call it endemic
William Schaffner, MD, an infectious disease expert at Vanderbilt University Medical Center in Nashville, is also in the endemic camp for three reasons.
First, he said: ‘We have very high herd immunity. We no longer see huge power surges, but we do see continuous, slow transmission. »
Additionally, while noting the concerning number of daily deaths and hospitalizations, Schaffner said, “It is no longer causing crises in health care or, beyond that, in the community economically and socially.”
“Number three, the disease-causing variants are Omicron and its progeny, the Omicron sub-variants. And whether it’s because of population immunity or because they’re inherently less virulent, they cause disease more benign,” Schaffner said.
Changing societal norms are also a sign that the United States is moving forward, he said. “Look around you. People behave endemic.
They get rid of masks, congregate in crowded spaces and ignore additional vaccines, “which implies some tolerance for this infection. We tolerate the flu,” he noted.
Schaffner said he would limit his scope to places where COVID is endemic or near endemic in the developed world.
“I’m more cautious about the developing world because our surveillance system isn’t as good,” he said.
He added a caveat to his endemic enthusiasm, conceding that a new, highly virulent variant that can resist current vaccines could torpedo endemic status.
No huge peaks
“I’m going to go with we’re endemic,” said Dennis Cunningham, MD, medical director of the infection control system at the Henry Ford Health System in Detroit.
“I use the definition that we know there are diseases in the population. It occurs regularly at a constant rate. In Michigan, we don’t have these huge spikes in cases anymore,” he said.
Cunningham said that while COVID deaths are concerning, “I would call cardiovascular disease endemic in this country and we have well over a few hundred deaths a day because of that.”
He also noted that the vaccines have resulted in high levels of disease control in terms of reduced hospitalizations and deaths.
The discussion really becomes an academic argument, Cunningham said.
“Even though we call it endemic, it’s still a serious virus that is really straining our healthcare system.”
not so fast
But not everyone is ready to go all-in with “endemic”.
Stuart Ray, MD, professor of medicine in the Division of Infectious Diseases at Johns Hopkins School of Medicine in Baltimore, said any endemic designation would be specific to a certain area.
“We don’t have a lot of information about what’s going on in China, so I don’t know if we can say what state they are in, for example,” he said.
Information in the United States is also incomplete, Ray said, noting that while home testing in the United States has been a great tool, it has made it difficult to get true case numbers.
“Our visibility into the number of infections in the United States has understandably been degraded by home testing. We need to use other means to glean what’s happening with COVID,” he said.
“There are people with infections that we don’t know about and something about that dynamic might surprise us,” he said.
There’s also a growing number of young people who haven’t had COVID yet, and with low vaccination rates among young people, “we could see spikes in infections again,” Ray said.
Why no official endemic declaration?
Some wonder why the endemic has not been declared by the WHO or the CDC.
Ray said health authorities tend to declare emergencies, but are slower to declare an emergency over if they make one.
President Joe Biden set May 11 as the end of the declaration of COVID emergency in the United States after extending the deadline several times. The state of emergency has allowed millions of people to receive free tests, vaccines and treatment.
Ray said we will only really know when the endemic started in retrospect.
“Just like I think we’re going to go back to March 9 and say Baltimore is out of winter. But there may be a storm that will surprise me,” he added.
Not enough time to know
Epidemiologist Katelyn Jetelina, PhD, MPH, director of population health analysis at the Meadows Mental Health Policy Institute in Dallas and senior CDC science consultant, said we haven’t had enough time with COVID to call it endemic.
For the flu, which is endemic, she says, “it’s predictable and we know when we’ll have waves.”
But COVID has too many unknowns, she said.
What we do know is that going endemic does not mean the end of suffering, said Jetelina, who also publishes a sub-pile titled Your local epidemiologist.
“We see it with malaria and [tuberculosis] and the flu. There is going to be pain,” she said.
Public expectations for tolerance of illness and death with COVID are still widely debated.
“We don’t have a metric for what is an acceptable level of mortality for an endemic. It’s more defined by our culture and our values and what we end up accepting,” she said. “That’s why we see this tug of war between urgency and normality. We decide where we place SARS-CoV-2 in our threat inventory. »
She said people in the US don’t know what these waves are going to look like – if they will be seasonal or if people can expect a summer surge in the South again or if another concerning variant will come out. From nowhere.
“I can see a future where (COVID) isn’t a big deal in some countries that have such high immunity from vaccinations and other places where it’s still a crisis.
“We are all hoping that we are getting closer to the endemic phase, but who knows? SARS-CoV-2 taught me to approach it with humility,” Jetelina said. “We don’t know what’s going to happen in the end.”