As we enter year three – Yes, three Of the COVID-19 pandemic, many of us are still struggling with the idea that there will not be a quick and safe end to this situation. And we can actually live with the virus for a while while we move into what experts call the “endemic” phase.
But what it actually looks like is still up for debate. Here’s what we know about endemism – and the experts’ best bet on what the future of COVID-19 can really mean.
What does “endemic” really mean?
Pandemics, epidemics and endemic are “concepts that people are a little confused about” right now, Dr. Raed Dweik, pulmonologist, critical care specialist and president of the Respiratory Institute at the Cleveland Clinic, TODAY.
A pandemic is an increase in the case of a particular disease that has spread to several parts of the world. An epidemic is an increase in cases that are confined to a small area, such as a foodborne disease outbreak in a few states or 2014 Ebola outbreak.
In contrast, an endemic virus is simply one that is a constant presence in a particular area of the world or in a particular population. The endemic level of a virus is its baseline or “the amount of a particular disease that is normally present in a community,” according to Center for Disease Control and Prevention. It is not necessarily present at the ideal level, but it is expected and somewhat predictable.
Definitions like these are unfortunately “very generic,” Dr. Richard Martinello, Associate Professor of Medicine in the Department of Infectious Diseases at the Yale School of Medicine, for TODAY. And they “do not really give us any parameters to say when something goes from being a pandemic to endemic.” Still, experts have a few predictions for what our future may look like with COVID-19 – and how the pandemic may gradually end.
What will the endemic phase look like for COVID-19?
In practice, many experts now see COVID-19 becoming endemic in a way that is similar to seasonal fluDr. Bernard Camins, medical director of infection prevention at Mount Sinai Health System, told TODAY.
“It’s endemic when it does not disrupt everyday life,” he said. While there may be some years that are particularly severe with the flu and others that are milder, even severe flu years do not interfere with health care, transportation, businesses, or our other usual routines to the same degree that COVID-19 has, Camins explained.
“In a pandemic, what we usually see are waves of disease. And these disease waves are exactly what we have been in and continue to experience,” Martinello said. “When a disease is endemic, we expect it to follow a seasonal pattern that we see with the flu or some of our cold viruses. “
This means that we may have more increases (possibly driven by new variants of coronavirus) later this year and perhaps for the next many years. But these waves are unlikely to be as disruptive as delta and omicron increases have been due to the rising general level of immunity – both from vaccination and infection – in the population. “As we move forward with this, the proportion of the population (who have a certain level of immunity) will get higher and higher,” Camins said. “And so it is when we move to endemicity.”
Dweik said the flu-like scenario is “the most likely and probably the best-case scenario.”
What we do not know is how widespread these future waves may be, or whether they will continue to follow the type of seasonal patterns we have already seen, Martinello said. But experts do not know when the endemic phase will really come. And in the meantime, they stress that we are still very much in the pandemic phase of COVID-19.
“My hospital has a little over 1,500 beds, and in the worst flu seasons, we can see 100 people being in our hospital with the flu,” Martinello said. “But just a few weeks ago we had 450 people in our hospital with COVID … That’s the difference: There may be a wave in itself, but the peak of the wave is very different (when a virus becomes endemic) . ”
Will we need more boosters, masks or other precautions in the future?
Whether we need it multiple COVID-19 shots depends on two main factors: how long the protection from our current series lasts, and whether there will be a variant that can avoid this protection significantly. For now, experts say it is too early to know for sure whether a fourth (or more) dose is needed.
But in the spirit of speculation, Dweik said, “I suppose we get an annual vaccine … we get a flu shot and COVID shot, and I think that’s going to be part of our routine annual vaccinations.” Camins agreed, adding that he does not expect us to need another booster until at least this fall – “except for another variant,” he said.
One of the benefits of COVID-19 mRNA vaccine technology is that it will take much less time to produce new versions of the vaccine to target different strains, should they become necessary, than it does for seasonal flu vaccines, Dweik explained. So they can be targeted more precisely to what is actually circulating if and when COVID-19 becomes a truly seasonal disease.
Concerning masks, Martinello said he sees them as having a new place in our approach to preventing the transmission of all kinds of diseases – not just COVID-19. “I do not expect us to have masks in the classrooms or in the workplace all the time,” he said. “But I think we can see more individual use of wearing masks. Maybe when we’re in the crowded situation, or when we go on a plane, many of us will choose to wear a mask – not because there is one. public health emergency, but because we just do not want to catch a cold. “
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