Most expertsthink that the coronavirus rather than being eliminated, SARS-CoV-2 will become endemic.
- When the disease shifts from pandemic to endemic, the health outcomes will be less severe and we as a society will be better able to manage the risks associated with COVID-19.
- But experts say it’s difficult to predict when this shift will happen.
At the start of the pandemic, infectious diseases experts believed that we’d eventually reach herd immunity with COVID-19 when the bulk of the population achieved protection either from natural infection or vaccination.
Endemic does not mean we’ll stomp out COVID entirely, but rather that we’ll learn to live with it and see less transmission and less severe outcomes in people who get infected.
“We will all be exposed to it at some point, and either will have no infection, mild infection, or severe infection,” said Dr. Jason Gallagher, an infectious disease expert, clinical professor at Temple University’s School of Pharmacy, and clinical pharmacy specialist in infectious diseases at Temple University Hospital.
“Vaccination shifts those outcomes towards positive ones but won’t completely eliminate infection,” he said.
Dr. Karen Edwards, a professor of epidemiology & biostatistics at the UCI Program in Public Health, says several factors determine when an infectious disease shifts from pandemic to endemic.
“First, endemic does not mean it will disappear,” Edwards said. “Instead, it means that it will still be around and may even increase during certain times of the year, but it will be at manageable and more or less at a constant level with largely predictable patterns over time.”
At a minimum, the reproduction rate — or how many other people an infected person spreads the virus to — should be around 1. According to Edwards, this is one of the key metrics epidemiologists look at.
The reproduction rate will fall as vaccinations increase.
“When enough people have immunity, this number will come down, but will depend largely on how many susceptible people (little to no immunity) there are in a population,” Edwards said.
Some countries — and even regions within a country — will reach this point before others since vaccination rates vary from place to place.
“We will likely still see surges and spikes primarily among those who are not vaccinated, but over time this should decrease as the number of susceptible individuals in a population decreases,” Edwards said.
Hospitalization and death rates will continue to fall as more people gain immunity and new medications to treat the infection are approved.
“In an endemic phase, cases will [develop] but won’t require widespread action unless they become out of control, such as in a poorly-vaccinated area,” Gallagher said.
Gallagher says COVID-19 has been hard to predict, and the Delta variant has taught us to stay humble. It’s impossible to know exactly what will unfold in the coming months and years.
That said, he does not expect there will be future lockdowns or mandates unless there’s a major change.
Edwards says we’ll essentially reach a point when we as a society are comfortable with the risks associated with being infected with SARS-CoV-2.
At that point, when the risk of becoming severely ill or dying is low, COVID-19 will enter a manageable phase where masks, distancing, shutdowns, and mandating vaccinations are no longer needed. This is how it goes with the flu.
Edwards said point out that flu season happens every year but we as a society are able to cope with it.
“We don’t wear masks, socially distance, or avoid large indoor crowds during flu season – even though all these measures would further reduce the risk of flu for everyone and save many lives each year,” Edwards said.
Some immunocompromised people who take extra precautions during flu season like socially distancing and wearing a mask may also do that to avoid COIVD-19.
Gallagher said that while it may seem far in the distance, we’ll reach that stage at some point.
“We are all so fixated on the ebbs and flows of the pandemic that it feels like it will never end,” he said. “But it will – all pandemics do.”
Though infectious diseases experts once thought COVID-19 could be eliminated, most now agree that the virus will become endemic.
When the disease shifts from pandemic to endemic, the health outcomes will be less severe, and we’ll be better able to manage and accept the low risks associated with COVID-19.
It’s unclear exactly when this shift will occur. But experts agree that one day we’ll treat COVID as we do the flu — masks and distancing will no longer be needed except in some circumstances, and our best line of defense will remain vaccination.