In the two years since SARS-CoV-2, the virus that causes COVID-19, began rapidly circulating across the globe, many people have had to learn a new vocabulary. It’s one of pandemics and antibodies, rapid tests, and vaccination rates.
But as the pandemic has continued, another word has been added to the collective lexicon: endemic. With the virus unlikely to disappear, global health experts want people to think of COVID-19 as an endemic disease, not a pandemic.
In other words, it’s a disease that’s always going to be around, not one for which there’s a definite end.
Read on to learn how a disease becomes endemic, what differentiates it from a pandemic, and how endemic diseases are managed.
The Centers for Disease Control and Prevention (CDC) says an
To put it another way, an endemic disease is consistently present, but it spreads at predictable rates that can be managed by communities.
These rates may be higher than desired levels, however. Currently, infections with SARS-CoV-2 and the resulting COVID-19 disease remain very high across the United States and the world.
But the number of new cases each day is beginning to stabilize. That is one sign the pandemic may be transitioning to endemic status.
Examples of endemic diseases
Influenza, also known as the flu, is a good example of an endemic disease. Despite vaccinations and effective treatments, the flu has a constant presence in the global community. In fact, the CDC says
In parts of the world, malaria is considered endemic. In the United States, it’s nearly eradicated because of safety measures, such as screens on doors and windows, spraying, and community efforts to reduce mosquito populations. But in other parts of the world, it remains a constant presence.
It’s important to remember that endemic diseases are no less harmful than pandemics. The diseases caused by endemic viruses are still dangerous, even deadly.
In short, these three levels of health outbreaks are defined by the rates of disease spread, not by the seriousness of the disease.
The SARS-CoV-2 virus provides us a good example of the three stages.
- Epidemic. In December 2019, the virus was considered an epidemic within a region of China.
- Pandemic. As the virus continued to spread, infections rapidly increased across the world. In March 2020, the COVID-19 outbreak was declared a pandemic by the
World Health Organization (WHO) . - Endemic. In 2022, as the spread of the disease and the number of infections stabilized, health experts began to discuss the possibility of COVID-19 becoming an endemic disease.
Endemic vs. epidemic
An endemic disease is stable and predictable. Compare that to an epidemic, which is a sudden, often unexpected rise in the number of cases of a particular disease. An epidemic is typically limited to a specific region or geographic area.
Examples of epidemics include measles and hepatitis A. However, not all epidemics are contagious.
Some health-related behaviors or conditions can be considered epidemics if the rates are clearly above what’s expected in a specific region or community. Obesity and opioid use are considered an epidemic in the United States, for example.
Endemic vs. pandemic
An epidemic can progress into pandemic status if the the virus or disease begins to spread to a wider area. In other words, where an epidemic is usually contained to a community or region, a pandemic can be international, even global.
Typically, a pandemic is the result of a new virus or virus strain for which people have no natural immunity. Because the SARS-CoV-2 virus was novel, it was able to spread rapidly, becoming a pandemic in a matter of months.
Other examples of pandemics include:
- the bubonic plague, which killed more than
25 million people - the 1918 flu epidemic, which killed
50 million people worldwide between 1918 and 1920 - smallpox, which killed millions of people worldwide as the virus spread
COVID-19 is likely to become an endemic disease. How quickly it will shift from pandemic to endemic is uncertain, however.
Endemic status requires a significant amount of immunity in populations worldwide.
The Omicron variant spread so rapidly on a global scale that it increased immunity very quickly. At the same time, worldwide vaccination efforts are helping to build immunity, too.
As a result, transmission has slowed, and the rates of COVID-19 cases are becoming more stabilized. This means that, despite high case numbers, COVID-19 is moving toward endemic status in the United States.
However, reaching endemic status also means communities must be resilient to potential new variants. If future variants evade natural immunity or immunity from vaccinations, the rate of infections may skyrocket again. This could return the 2019 coronavirus to pandemic or epidemic status.
Since the emergence of SARS-CoV-2 infections and COVID-19 in 2019, the pandemic has caused widespread disruptions to work, travel, and leisure activities. It’s led to economic loss and hardships all over the world.
That, of course, doesn’t account for the millions who’ve died as a result of the infection.
As with pandemics before, COVID-19 will likely change the landscape of typical life. For example, yellow fever and malaria epidemics led to the use of screens on doors and windows. Typhoid and cholera outbreaks brought about community health changes, such as clean water and reliable sewer systems.
During the outbreak of the Ebola virus in West Africa in 2014, community health efforts were able to stop the spread of the virus and end the epidemic before it spread globally. That is not the type of expectation anyone should have for COVID-19.
The most likely outcome of the COVID-19 pandemic is that the virus transitions to endemic status, not that it disappears entirely.
Endemic COVID-19 may translate to continued mask wearing in places like public transportation, indoor settings, and offices. This may be especially important during wintertime peaks, when respiratory viruses like SARS-CoV-2 are easier to transmit.
But with good community efforts, high vaccination rates, and improved treatments, COVID-19 can potentially become a predictable disease that communities can cope with, much as they do the seasonal flu.
People can gain immunity to the novel coronavirus through vaccinations and natural infections. This level of immunity will help slow the transmission of the virus and reduce cases of COVID-19. Ultimately, this can help stabilize hospitalizations and deaths, too.
But the transition from pandemic to endemic is gradual. It doesn’t happen overnight, and it will still require vigilance by average people, as well as medical professionals.
Mutations could delay the transition. If a new variant begins to surge, much like Omicron did at the end of 2021, the entire global community may have to take steps to slow transmission and reduce the spread of the virus once again.
For now, vaccination efforts remain a key step in ending the pandemic and transitioning to an endemic.
SARS-CoV-2 may never go away, but vaccines and effective treatments can make the virus more predictable and less destructive, which will allow people more freedom in their day-to-day-lives.