When we talk about reaching the ‘endemic’ stage of COVID, what does that mean?
In two separate January press conferences, Gov. Roy Cooper said that North Carolina needs to reach the “endemic” stage of the COVID-19 pandemic, allowing schools, businesses and government operations to remain open and running smoothly, even as the virus remains ubiquitous.
“We want to get this virus to the endemic stage,” Cooper said on Friday, Jan. 7. “We understand that this virus is going to be with us for a long time, but we need to make sure that we can lead normal lives and live with it, protect ourselves and try to reduce people getting sick and dying from this virus.”
At a March 17 press conference, Cooper and state Department of Health and Human Services Secretary Kody Kinsley said that the state is entering a “new phase” of the pandemic focused on individual responsibility and collective preparedness to manage the virus moving forward.
But, Kinsley said, the endemic stage of the virus has “yet to be seen” in the state.
So, what does it mean to move from “pandemic” to “endemic”? And what will an endemic stage of COVID-19 look like?
To answer those questions and more, The News & Observer spoke with Dr. David Wohl, an infectious disease specialist with UNC Health. We also consulted source material at the Centers for Disease Control and Prevention.
Here’s what we learned.
What does ‘endemic’ mean?
Endemic is part of a group of terms used to describe the level, or amount, of a particular disease in a community.
▪ Endemic describes the baseline, or expected, level of the disease, explains the CDC.
▪ The endemic level of a disease does not necessarily mean that the disease is not present in the community. While having zero disease may be the desired outcome for many diseases, endemic refers to the baseline, observed level of the disease.
▪ The endemic level of a disease assumes that, without intervention and assuming there is not a high enough level of disease to deplete the susceptible population, the disease will continue to exist at the baseline level indefinitely.
In practice, when a disease or pathogen reaches an endemic stage, it becomes part of the “normal landscape of the germs that we encounter,” Wohl said.
Other terms used to describe the level of disease in a community include:
▪ Sporadic: A disease that occurs infrequently and irregularly.
▪ Hyperendemic: Persistent, high levels of disease.
▪ Epidemic: A sudden increase in the number of cases of a disease that is more than what is normally expected for a certain area.
▪ Cluster: An aggregation of cases grouped in place and time that are suspected to be greater than the number expected.
▪ Pandemic: An epidemic that has spread over several countries or continents, affecting a large number of people.
Note: Endemic is a descriptive term, not a noun. If COVID-19 becomes endemic, the disease will have endemic properties, or could be described as an endemic disease — not simply “an endemic,” like you might have said “a pandemic.”
What are examples of endemic diseases?
Wohl gave some examples of diseases that are endemic, including malaria.
“Places of the world where there’s malaria, malaria is endemic,” Wohl said. “It doesn’t go and come and then go. It stays around.”
Other coronaviruses that cause colds are also endemic, Wohl said.
Has COVID-19 become endemic? Will it?
There isn’t a set or widely accepted threshold for when a disease becomes endemic.
Wohl said that COVID-19 could reach an endemic stage if both of the following conditions are met:
- There is broad immunity against the virus in the population, achieved by enough people being infected with COVID or vaccinated against the virus, or through a combination of the two.
- There is some amount of inherent weakness in the virus that causes less severe illness.
Wohl said there is hope that the omicron variant of COVID, which is generally less severe than other variants — namely the delta variant — could allow COVID to plateau and reach an endemic level.
“The happy ending scenario for the pandemic is omicron muscles out other variants,” Wohl said.
If omicron were to become the “dominant position” of variants, Wohl said, more people could become immune to the virus, either through infection, which would likely be less severe than other variants, or through vaccination and boosters.
If that happens, Wohl said, the virus could plateau and reach a reprieve, similar to case levels this summer, before the delta variant emerged.
At that point, COVID might become similar to other, natural coronaviruses and colds: “We catch it regularly, we get the sniffles, we get through it after a few days,” Wohl said.
Wohl said it may be difficult for the virus to become endemic, though, as long as there continues to be a large group of people who are vulnerable to getting really sick — generally, those who are unvaccinated.
What will endemic COVID look like?
If COVID-19 becomes endemic, it will become an infection that is “part of our normal germ landscape from here on out,” Wohl said.
The disease will still transfer from person to person, but the consequences of the virus will be very limited, and it will generally cause less severe illness.
That will allow hospitals and the health care system to return to some level of normal, where they are not overwhelmed by a disease that they were not built to manage, Wohl said. Instead, they’ll be able to shift their focus back to illnesses and injuries such as broken legs, heart attacks and appendicitis.
In your every day life during an endemic stage of the virus, you may be more comfortable taking off your mask in public and eating inside at restaurants again, as the consequences of the virus will be less severe and more manageable.
This story was originally published January 7, 2022 at 5:14 PM.
