All of us are asking an intuitive question, will Covid-19 become an endemic disease someday?
It is still very difficult to predict the future development of “Covid-19”, while it is easy to predict the reaction of humans because history is our guide in that.
One of the most insightful articles on the future of the epidemic was Gina Colata’s article “How Pandemics end”, published in May 2020 in the New York Times, as it was supported by the opinions of medical historians who described society’s reactions to Ebola, the black plague and the Spanish flu in 1918.
The pandemic had a biological end, with fewer infections and deaths, as well as a social end when people grew tired of fear and took a certain amount of risk to resume social and business life. The end of a social pandemic sometimes comes first.
It is not surprising that after two years of living with Covid, many people are less afraid of the virus, and even eager to return to a more normal life.
People want a term to describe the better future we envision. We talked about “herd immunity” in 2020, and now we use the term “endemic viruses” instead.
Endemic Virus May Not be a Precise Term
The spread of the delta variant among vaccinated groups weakened hope for herd immunity, then the Omicron variant came to further exacerbate it.
This is how the talk about “endemic viruses” emerged, as exhausted peoples want a psychological crutch to lean on. Although the meaning of “endemic” is broad, experts disagree about it.
Professor Aris Katzourakis, a biologist at the University of Oxford, argues that the term “endemic” is used misleadingly, to indicate that the pandemic will end without us doing more. In a Nature article entitled “Covid-19: Endemic Viruses Don’t Mean Harmless”, Katzourakis described the word “endemic” as one of the most misused epidemiological terms.
“Endemic,” Katzourakis said, refers to a condition in which the total number of infections neither decreases nor increases, although the endemic disease may have large, predictable seasonal fluctuations. Endemic diseases can also be deadly and devastating, as the common cold is considered endemic and so is malaria, which kills 600,000 people each year. “Endemic disease can be low prevalence or widespread, and it can be serious or not,” Katzourakis said.
Endemicity often does not last, as a disease such as influenza can be epidemic or endemic. When new strains are transmitted from animals, influenza can cause a pandemic, as was the case with swine flu in 2009.
This same strain of influenza is now stable and endemic. The same virus can have both descriptions, depending on its instantaneous behavior.
Endemic Virus Doesn’t Mean Getting Back to Normalcy
The “endemic” status does not mean that it is time to return to normal. Journalist Maryn McKenna wrote recently in Wired: “Endemicification…is not a promise of safety. It’s a guarantee that you’ll remain vigilant at all times, according to epidemiologist Ellie Murray.”
But people will not be wary all the time, as some will remain anxious while others have long since returned to normalcy and other concerns. But this is no reason to believe that the battle against this virus is coming to an end.
What public health authorities can do now is apply the lessons of the two-year experience by launching humane, sustainable, life-saving and preventive activities against new variants.
One step is to make more and better vaccines, as well as to produce and transport antiviral drugs to countries with low levels of vaccination.
Although there is some dispute about how the new variants arose, the main suspects are unvaccinated people who suffer from untreated diseases such as HIV, in which the virus can multiply and develop within them over weeks or months.
New protocols for rapid testing could protect nursing homes and make hospitals and doctors’ offices safer.
Salaried employees and temporary workers around the world need better sick leave and a safety net, which Dr Moggie Civic has been advocating in the UK since the spring of 2020, when she saw how many people were seriously ill without being able to leave work even for a few days.
Sustainable Solutions Instead of Using the Term “Endemic Virus”
Harvard University’s Joseph Allen said moving to healthy, well-ventilated buildings could prevent illness and death after he advocated the use of masks early in the pandemic. Allen told us in the fall that we should start looking for solutions that might be sustainable and have multiple benefits.
William Hanage, another researcher from the Harvard School of Public Health, has long argued that we may not see a stable, predictable incidence of disease for some time. But we need better monitoring and data to prepare for a future of more waves of ups and downs.
Data on the increase in infections and outbreaks could be more consistent, reliable and accessible, physician and researcher Eric Topol has argued. People take precautions when the matter is most urgent. It is unrealistic to expect people to change their lifestyles to avoid infection indefinitely.
We don’t know how the virus will evolve in the future, but a long history tells us how people will behave. Whether we use the term “endemic” or find another term to describe the post-Covid-19 crisis, there are ways to keep pace with the war on the virus, through measures aimed at protecting people rather than changing them, to continue as we have always without turning into archetypes as Public health officials wish.
