It’s (finally) time to stop calling it a pandemic: Experts

March 17, 2023 – 3 years since the World Health Organization was founded officially announced the COVID-19 emergency is a pandemic. Now that health systems are no longer overwhelmed and no surprises have been expected for more than a year, many infectious disease experts say the crisis is turning from pandemic to endemic.

Endemic generally means that the virus and its patterns are predictable and constant in designated regions. But not all experts agree that we are here.

Eric Topol, MD, founder and director of the Scripps Research Translational Institute in La Jolla and editor-in-chief of Medscape, WebMD’s sister site for health professionals, said it’s time to call COVID endemic.

He wrote in Substack, Earthly Justicethat all indications — a genomic monitoring of the virus to sewage clinics the results that are still being tracked — points to a new reality: “[W]I (finally) entered the endemic phase. “

No new SARS-CoV-2 variants with a growth advantage over XBB.1.5 have yet emerged, which dominant in most of the worldor XBB.1.9.1 – wrote Topol.

But he has two problems. One is the daily number of hospitalizations and deaths – around 26,000 and 350, respectively. The New York Times COVID tracker. This is much more than the daily death toll during a severe flu season.

“This is well over (double) where we were in June 2021,” he wrote.

Topol’s second concern is the chance that a new family of viruses could evolve that are even more infectious or deadly—or both—than the recent Omicron variants.

Three reasons why it can be called endemic

William Schaffner, MD, an infectious disease expert at Vanderbilt University Medical Center in Nashville, is in the endemic camp for three reasons.

First, he said, “We have very high population immunity. We are no longer seeing huge ripples, but we are seeing constant smoldering transmission.”

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Schaffner, while noting the alarming number of daily deaths and hospitalizations, said “it is no longer a crisis in health care, and beyond that in the community either economically or socially.”

“Third disease-causing variants are Omicron and its offspring, the Omicron sub-variants. And either because of population immunity or because they are inherently less virulent, they cause milder diseases,” Schaffner said.

Changing social norms are also a sign that the United States is moving on, he said. “Look around. People behave endemically.”

They take off their masks, gather in crowded places, and get additional vaccines, “which means a certain tolerance to this infection. We endure the flu,” he noted.

Schaffner said he is limiting the endemic or near-endemic area of ​​COVID to the developed world.

“I’m more cautious about the developing world because we don’t have that good of a surveillance system there,” he said.

He added a caveat to his endemic enthusiasm, acknowledging that a highly virulent new strain resistant to current vaccines could torpedo endemic status.

There are no huge peaks

“I’m going to say we’re endemic,” said Dennis Cunningham, MD, medical director of infection prevention at Henry Ford Health System in Detroit.

“I use the definition that we know there are diseases in the population. It occurs regularly and at a steady pace. We’re not seeing a huge spike in cases in Michigan anymore,” he said.

Cunningham said while the number of deaths from COVID is troubling, “I would call cardiovascular disease endemic in this country, and it kills well over a few hundred a day.”

He also noted that vaccines have resulted in a high level of control of the disease in reducing hospitalizations and deaths.

The debate really becomes an academic argument, Cunningham said.

“Even if we call it endemic, it’s still a serious virus that puts a lot of strain on our healthcare system.”

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Not so fast

But not everyone is ready to go all-in with the “endemic”.

Stuart Ray, MD, professor of medicine in the division of infectious diseases at the Johns Hopkins School of Medicine in Baltimore, said each endemic designation applies to a specific area.

“We don’t have a lot of information about what’s going on in China, so I don’t know if we can say, for example, what their condition is,” he said.

Information in the U.S. is also incomplete, Ray said, noting that while home testing in the U.S. has been a great tool, it has made it difficult to count true cases.

“Our visibility into the number of infections in the US has understandably been impaired by home testing. We have to use other tools to find out what’s going on with COVID,” he said.

“There are people who have infections that we don’t know about, and something from that dynamic might surprise us,” he said.

There are also a growing number of young people who have not yet had COVID, and with low vaccination rates among young people, “we may see a spike in infections again,” Ray said.

Why is there no official endemic declaration?

Some question why it has not been declared endemic by the WHO or CDC.

Ray said health authorities tend to declare emergencies, but are slower to announce the end of an emergency, if at all.

Appointed by President Joe Biden May 11 is the end the declaration of a COVID emergency in the United States after several extensions of the deadline. The emergency allowed millions to receive free tests, vaccinations and treatments.

Ray said we’ll only know in hindsight when the endemic started.

“The same way I think we look back on March 9 and say it’s not winter in Baltimore. But there might be a storm that will surprise you,” he helps.

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There isn’t enough time to know

We haven’t had enough time with COVID to call it endemic, said epidemiologist Katelyn Jetelina, PhD, MPH, director of population health analysis at the Meadows Mental Health Policy Institute in Dallas and chief scientific advisor to the CDC.

For the flu, which is endemic, he said, “It’s predictable and we know when there will be waves.”

But COVID has too many unknowns, he said.

What we do know is that going endemic doesn’t mean the end of suffering, said Jetelina, who also publishes a Substack. Your local epidemiologist.

“We see that malaria and [tuberculosis] and influenza. There will be suffering,” he said.

The public’s expectations regarding tolerance of illness and death caused by COVID are still widely debated.

“We don’t have a measure of what is an acceptable level of mortality in an endemic. It’s more about our culture and our values ​​and what we ultimately accept,” he said. “That’s why we see this tug-of-war between urgency and normality. We decide where to place SARS-CoV-2 in terms of threats in his repertoire.”

He said people in the U.S. don’t know what those waves will look like — whether they will be seasonal, or if they can expect another summer wave in the South, or if another version of the worry will come out of nowhere.

“I see a future where (COVID) is not a big deal in certain countries where immunity is so high through vaccinations and in other places where it is still a crisis.

“We all hope that we are approaching the endemic stage, but who knows? SARS-CoV-2 taught me to approach it with humility,” said Jetelina. “In the end, we don’t know what will happen.”