Signs the coronavirus is becoming endemic | TheHill – The Hill

February 18, 2022

With the omicron surge in descent, some government officials and health experts have begun talking about the potential for the coronavirus to become endemic and lifting restrictions like mask mandates. Although we still dont have a clear sense for what endemicity could look like for this disease, or when we could get there, there are some emerging ideas for what signs to look for. These include stability and predictability.

The simplest understanding of what makes a disease endemic is that it is one that is not going away. Endemic diseases can have large ranges for prevalence depending on the characteristics of how its persisting in the population. In contrast, there have been pathogens that emerge and then disappear, such as the original SARS coronavirus that caused outbreaks in 2003, never establishing itself in the human population in the long term.

The larger question is how to differentiate endemic from pandemic. Experts say there are a few signs to keep an eye out for.

When asked what to look for, one key sign is stability,said Tara Smith,a professor at the College of Public Health at Kent State University, in an email to Changing America. Fewer cycles of surge-and-decline and less of the epidemic stage that has overwhelmed hospitalsand not only here, but around the globe.

As weve seen with the omicron variant, relative stability achieved in one country is not sustainable if there isnt enough stability worldwide to prevent a new variant from emerging.

Another sign a pathogen is becoming endemic is predictability. An endemic disease typically has predictable patterns across time and space. Its about looking both backward and forward,said Delivette Castor, of the Department of Medicine at Columbia University, to Changing America. That means looking at the history of coronavirus and using that data to be able to project forward in a reliable way. Currently, researchers creating models for projecting scenarios of coronavirus may only be able to do so for a few weeks or months out, let alone for entire year-long cycles.

But this also excludes the potential for new variants that are different from what weve seen previously, and researchers cant predict those. Many infectious diseases researchers have focused their careers on trying to predict when or what new pathogens will emerge, and its a tough job. For example, scientists are not always able to predict how influenza will change and which strains will be dominant every year. It might take many years to understand how the SARS-CoV-2 coronavirus mutates and changes, and even then we may not be able to predict which versions will take off in humans.

But if it can be achieved even on a small level, predictability should be able to inform preparation and response strategies.

What does it mean in terms of preparation of ICUs, the ability of the emergency department to respond, the ability to deploy testing early enough to be able to catch signals, the ability to sustain random testing centers for good surveillance, Castor said.

Part of the task of defining what endemic means for coronavirus could be establishing what threshold level of cases is tolerable. If the coronavirus settles into seasonal patterns, then wed have to figure out the expected ranges for case rates for different times of the year.

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In 2020, New York City public schools were closed when an overall 3 percent positivity rate for coronavirus testing was reached in the city. Whether this was the right move at the time is up for question, but it may not be ideal to have rigid thresholds for all age groups and situations. In addition, reliance on rapid testing has risen as availability has increased. In some school districts, rapid tests have become crucial for protocols for deciding when to keep students in school. If fewer people follow up with PCR lab tests and especially if fewer asymptomatic cases are detected, that could mean those results are not as indicative of the populations COVID status as it once was.

In preparing strategies for the pandemic to recede into endemicity, the global aspect is key, experts say.

If we focus solely on the US, we are missing an enormous part of the picture. A pandemic is global by definition,said Smith.

Just as each state in the U.S. is intricately linked to those around it and even those that are far away, weve also learned that countries on all continents are linked. An emergence of a new variant on one continent has inevitably led to spread to most others. It may be possible to independently start behaving like it is no longer a pandemic, but that may not be the reality on the whole.

This means we will have to see if there is stability and predictability globally. Its hard enough within the U.S. with waves starting and cresting at different times across the country, but we need to also consider what is happening in other countries, experts say.

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