Endemic COVID-19

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As of June 2023, COVID-19 is a pandemic, but it could become endemic in a future phase. The observed behavior of SARS-CoV-2, the virus that causes COVID-19, suggests it is unlikely it will die out, and the lack of a COVID-19 vaccine that provides long-lasting immunity against infection means it cannot immediately be eradicated; thus, a future transition to an endemic phase appears probable. In an endemic phase, people would continue to become infected and ill, but in relatively stable numbers.[1] Precisely what would constitute an endemic phase is contested.

On May 5, 2023, the World Health Organization ended the public health emergency of international concern regarding COVID-19, but still considered the outbreak to be a pandemic.[2] Since 2021, some politicians and health officials in some countries have said that COVID-19 is endemic locally or that their country was beginning to transition to an endemic phase.

Definition and characteristics

An infectious disease is said to be endemic when the number of infections is predictable.[3] This includes diseases with infection rates that are predictably high (called hyperendemic), as well as diseases with infection rates that are predictably low (called hypoendemic).[3][4]

In January 2022, paleovirologist Aris Katzourakis wrote that the word "endemic" is one of the most misused of the COVID-19 pandemic, and that it is dangerously complacent to assume that COVID-19 endemicity is inevitable, or that it means the disease will necessarily become less of a threat to public health. A stable infection rate can be associated with any level of disease severity and any level of mortality rate among affected people. Additionally, if a disease becomes endemic, there is no guarantee that the disease will remain endemic forever. A disease that is usually endemic can become epidemic or pandemic in the future.[4]

There is no single agreed definition of what it means for COVID-19 to become endemic.[5] According to historian Jacob Steere-Williams, what endemicity means has evolved since the 19th century and the desire to label COVID-19 as being endemic in early 2022 was a political and cultural phenomenon connected to a desire to see the pandemic as being over.[6] International Nursing Review journal editor Tracey McDonald warned in a 2023 paper on achieving an endemic status for COVID-19 how, "Traps for unwary politicians and commentators include statements on scientific matters that fall well outside their knowledge and experience, and the danger of adopting and misusing esoteric terminology that has nuanced meanings within professional circles."[7]

During the course of the COVID-19 pandemic, it became apparent that the SARS-CoV-2 virus was unlikely to die out, but was more likely to become endemic. Endemicity is characterized by the continued existence of the virus, but with more predictable numbers of infection than in the preceding epidemic. People continue to become infected because of changes and movement within populations, and endemic disease may have seasonal infection patterns, but the largest determinant of how endemicity manifests itself is the levels of immunity people have, both as a result of vaccination and infection. In the absence of a vaccine that provides long-lasting immunity against infection from COVID-19, it will be impossible to eradicate the disease.[1]

The severity of a disease in an endemic phase depends on how long-lasting immunity against severe outcomes is. If such immunity is lifelong, or lasts longer than immunity against infection, then reinfections will be mild, resulting in a mild endemic phase. In other existing human coronaviruses, protection against infection is transient, but observed reinfections are mild.[1]

Global status

On 14 April 2022, the World Health Organization (WHO) said that COVID-19 is far from becoming an endemic disease and could still trigger large outbreaks around the globe.[8] The WHO declared that COVID-19 no longer represents a public health emergency of international concern on 5 May 2023, but stated that it remains a pandemic.[9][10] (The WHO does not declare the beginning or end of pandemics.[11][12])

An article in Human Genomics said that the endemic phase of COVID-19 would require worldwide vigilance and cooperation, especially in emerging countries", and suggested that developed countries should assist in boosting COVID-19 vaccination rates worldwide.[13]

In October 2022, a report on COVID-19 commissioned by The Lancet assessed that COVID-19 endemicity was likely but that the course of the pandemic was still not predictable. The report said endemicity could give rise to a new pandemic of long COVID that would cause significant strain on nations' economies and healthcare systems because of the health and social care required to treat people.[14]

As of March 2023, it was not possible to predict the infection patterns COVID-19 would settle on, though as with other coronaviruses it seemed possible the pattern would not be a seasonal one of the kind seen with influenza.[15]

See also


  1. ^ a b c Antia R, Halloran ME (October 2021). "Transition to endemicity: Understanding COVID-19". Immunity (Review). 54 (10): 2172–2176. doi:10.1016/j.immuni.2021.09.019. PMC 8461290. PMID 34626549.
  2. ^ Nolen, Stephanie (5 May 2023). "W.H.O. Ends Global Health Emergency Designation for Covid". New York Times. Retrieved 5 May 2023.
  3. ^ a b "Principles of Epidemiology in Public Health Practice, Third Edition An Introduction to Applied Epidemiology and Biostatistics". Centers for Disease Control and Prevention. Retrieved 19 April 2018.
  4. ^ a b Katzourakis A (January 2022). "COVID-19: endemic doesn't mean harmless". Nature. 601 (7894): 485. Bibcode:2022Natur.601..485K. doi:10.1038/d41586-022-00155-x. PMID 35075305. S2CID 246277859.
  5. ^ Duong D (October 2022). "Endemic, not over: looking ahead to a new COVID era". CMAJ. 194 (39): E1358–E1359. doi:10.1503/cmaj.1096021. PMC 9616156. PMID 36220172.
  6. ^ Steere-Williams J (May 2022). "Endemic fatalism and why it will not resolve COVID-19". Public Health. 206: 29–30. doi:10.1016/j.puhe.2022.02.011. ISSN 0033-3506. PMC 8841151. PMID 35316742.
  7. ^ McDonald T (March 2023). "Are we there yet? A guide to achieving endemic status for COVID-19 and variants". Int Nurs Rev (Editorial). 70 (1): 1–6. doi:10.1111/inr.12823. PMC 9880758. PMID 36571833.
  8. ^ "WHO warns coronavirus is far from settling into endemic situation". Al Jazeera. 14 April 2022. Retrieved 8 November 2022.
  9. ^ "Covid global health emergency is over, WHO says". BBC News. 5 May 2023.
  10. ^ "Statement on the fifteenth meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic".
  11. ^ Rigby, Jennifer; Satija, Bhanvi (8 May 2023). "WHO declares end to COVID global health emergency". Reuters. Retrieved 9 May 2023.
  12. ^ Gregory, Andrew (5 May 2023). "Covid-19 is no longer a global health emergency, says WHO". The Guardian. Retrieved 9 May 2023.
  13. ^ Biancolella, Michela; Colona, Vito Luigi; Mehrian-Shai, Ruty; Watt, Jessica Lee; Luzzatto, Lucio; Novelli, Giuseppe; Reichardt, Juergen K. V. (2022). "COVID-19 2022 update: Transition of the pandemic to the endemic phase". Human Genomics. 16 (1): 19. doi:10.1186/s40246-022-00392-1. PMC 9156835. PMID 35650595. S2CID 249274308.
  14. ^ Sachs JD, Karim SS, Aknin L, Allen J, Brosbøl K, et al. (October 2022). "The Lancet Commission on lessons for the future from the COVID-19 pandemic". Lancet. 400 (10359): 1224–1280. doi:10.1016/S0140-6736(22)01585-9. PMC 9539542. PMID 36115368.
  15. ^ Cohen C, Pulliam J (March 2023). "COVID-19 infection, reinfection, and the transition to endemicity". Lancet. 401 (10379): 798–800. doi:10.1016/S0140-6736(22)02634-4. PMC 9934854. PMID 36930672.